Predictors of Mortality in Redo Aortic Valve Replacement for Prosthetic Aortic Valve Endocarditis

Background: One of the most dreaded complications and a source of significant mortality after aortic valve surgery is prosthetic aortic valve endocarditis. Many studies were done to address the risk factors for hospital mortality and responsible for prolonged postoperative hospital stay. Patients and Methods: Thirty patients underwent the study from September 2019 to March 2020 at Kasr Al-Aini University Hospitals, Cairo, and Beni Suef University Hospital, Egypt. Preoperative, operative, and postoperative data to determine the risk factors for hospital mortality were collected. Result: The study included 16 (53.3%) males and 14 (46.7%) females. With mean age ±SD 38.5±7.7 years. The most prevalent isolated organism was staph aureus (30%) followed by coagulase negative staph (20%) then enterococcus fecalis and streptococcus bovis (13.3%). The hospital mortality was 26.7%. Pre-operative predictors of in-hospital mortality were CHF (p value 0.011), DM (p value 0.012), NYHA III&IV (p value 0.014), preoperative need to inotropic (p value 0.011), preoperative need to mechanical ventilation (p value 0.017), presence of aortic root abscess (p value 0.003). Intraoperative predictors of mortality were prolonged CPB time (p value 0.001), prolonged clamping time (p value <0.001). While postoperative predictors were low COP (p value 0.027) and postoperative sepsis (p value 0.029). Conclusion: Once infective endocarditis suspected in patient has prosthetic valve combined management should be taken to minimize the perioperative complications and hence the operative mortality risk minimized.