Recurrent substance use and reoperative valve surgery for acute infective endocarditis

IF 1.9

JTCVS open Pub Date : 2025-06-01 DOI:10.1016/j.xjon.2025.03.013

Hakam Rajjoub BS, Stanley Wolfe MD, MPH, Luigi F. Lagazzi MD, Lawrence Wei MD, Ali Darehzereshki MD, Nestor Dans MD, Nathan Kister MD, Goya Raikar MD, Vinay Badhwar MD, J. Hunter Mehaffey MD, MSc

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引用次数: 0

Abstract

Objective

Reoperative valve surgery in the setting of infective endocarditis (REDO) conveys a high risk of morbidity and mortality. Recurrent substance use in patients with substance use disorder (SUD) may complicate decision making in valve reinfection. We sought to evaluate the relative impact of recurrent substance use in REDO.

Methods

An institutional multidisciplinary endocarditis database, including Society of Thoracic Surgeons (STS) data, was analyzed for all patients undergoing isolated or concomitant valve surgery for acute infective endocarditis between July 2016 and June 2024. Patients were stratified by REDO and recurrent substance use. Multivariable regression modeling assessed the interaction between REDO and SUD on risk-adjusted outcomes.

Results

A total of 741 consecutive patients undergoing valve surgery for endocarditis were analyzed, including 475 with SUD (64.1%) and 210 undergoing REDO (28.3%). The incidence of second or further REDO was higher among SUD patients compared to non-SUD patients (23.1% vs 16.1%; P = .003). Compared to first-time valve surgery, REDO was associated with higher rates of mortality (7.6% vs 2.6%; P = .002) and major morbidity (31.9% vs 23.0%; P = .012). After risk adjustment, REDO was associated with increased STS composite mortality or major morbidity in non-SUD patients (odds ratio [OR], 4.6; P = .005) but not in SUD patients (OR, 1.4; P = .271). However, >2 reoperations in the setting of recurrent substance use was associated with higher risk-adjusted major morbidity or mortality (OR, 6.23; P < .0001).

Conclusions

Reoperation for infective endocarditis is associated with increased morbidity and mortality. For patients with recurrent substance use, initial reoperative surgery did not independently impact outcomes, but multiple reoperations did. These data can inform surgical decision making when approaching recurrent endocarditis due to recurrent substance use.

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急性感染性心内膜炎复发性药物使用及再手术治疗

目的感染性心内膜炎（REDO）的瓣膜手术具有很高的发病率和死亡率。药物使用障碍（SUD）患者复发性药物使用可能使瓣膜再感染的决策复杂化。我们试图评估在REDO中反复使用物质的相对影响。方法分析2016年7月至2024年6月期间，包括胸外科学会（STS）数据在内的机构多学科心内膜炎数据库中所有因急性感染性心内膜炎接受单独或合并瓣膜手术的患者。根据REDO和复发性药物使用情况对患者进行分层。多变量回归模型评估了REDO和SUD对风险调整结果的相互作用。结果共分析连续741例心内膜炎瓣膜手术患者，其中475例为SUD(64.1%)， 210例为REDO（28.3%）。与非SUD患者相比，SUD患者第二次或进一步REDO的发生率更高(23.1% vs 16.1%；P = .003)。与首次瓣膜手术相比，REDO与更高的死亡率相关(7.6% vs 2.6%；P = 0.002)和严重发病率(31.9% vs 23.0%；P = .012)。风险调整后，REDO与非sud患者STS复合死亡率或主要发病率增加相关(优势比[or]， 4.6；P = .005)，但在SUD患者中没有(OR, 1.4；P = .271)。然而，在反复使用药物的情况下再次手术与更高的风险调整后的主要发病率或死亡率相关(or, 6.23；P & lt;。)。结论感染性心内膜炎的再手术与发病率和死亡率增高有关。对于复发性药物使用的患者，首次再手术不单独影响结果，但多次再手术会影响结果。这些数据可以为外科手术决策提供依据，以应对因反复使用药物引起的心内膜炎。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JTCVS open

CiteScore

1.70

自引率

0.00%

发文量