Emergency surgery for native mitral valve endocarditis: the impact of septic and cardiogenic shock

Ann Thorac Surg. 2012 May;93(5):1469-76. doi: 10.1016/j.athoracsur.2011.11.025. Epub 2012 Feb 17.


Background: Limited information exists about the real impact of the etiology of shock on early and late outcome after emergency surgery in acute native mitral valve endocarditis (ANMVE). This multicenter study analyzed the impact of the etiology of shock on early and late outcome in patients with ANMVE.

Methods: Data were collected in eight institutions. Three hundred-seventy-nine ANMVE patients undergoing surgery on an emergency basis between May 1991 and December 2009 were eligible for the study. According to current criteria used for the differential diagnosis of shock, patients were retrospectively assigned to one of three groups: group 1, no shock (n=154), group 2, cardiogenic shock (CS [n=118]), and group 3, septic shock (SS [n=107]). Median follow-up was 69.8 months.

Results: Early mortality was significantly higher in patients with SS (p<0.001). At multivariable logistic regression analysis, compared with patients with CS, patients with SS had more than 3.8 times higher risk of death. That rose to more than 4 times versus patients without shock. In addition, patients with SS had 4.2 times and 4.3 times higher risk of complications compared with patients with CS and without shock, respectively. Sepsis was also an independent predictor of prolonged artificial ventilation (p=0.04) and stroke (p=0.003) whereas CS was associated with a higher postoperative occurrence of low output syndrome and myocardial infarction (p<0.001). No difference was detected between groups in 18-year survival, freedom from endocarditis, and freedom from reoperation.

Conclusions: Our study suggests that emergency surgery for ANMVE in patients with CS achieved satisfactory early and late results. In contrast, the presence of SS was linked to dismal early prognosis. Our findings need to be confirmed by further larger studies.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Cardiac Surgical Procedures / methods
  • Cardiac Surgical Procedures / mortality
  • Cohort Studies
  • Confidence Intervals
  • Critical Illness
  • Emergency Treatment / methods
  • Endocarditis, Bacterial / diagnostic imaging
  • Endocarditis, Bacterial / mortality
  • Endocarditis, Bacterial / surgery*
  • Female
  • Hospital Mortality / trends
  • Humans
  • Kaplan-Meier Estimate
  • Logistic Models
  • Male
  • Middle Aged
  • Mitral Valve / pathology*
  • Mitral Valve / surgery
  • Multivariate Analysis
  • Odds Ratio
  • Proportional Hazards Models
  • Registries
  • Retrospective Studies
  • Risk Assessment
  • Shock, Cardiogenic / diagnosis
  • Shock, Cardiogenic / mortality
  • Shock, Cardiogenic / surgery*
  • Shock, Septic / diagnosis
  • Shock, Septic / mortality
  • Shock, Septic / surgery*
  • Survival Analysis
  • Ultrasonography