Abstract 14886: Outcome of Early Surgery in Active Infective Endocarditis in Terms of Intraoperative Valve Culture

Abstract

Introduction: In recent years, the benefit of early surgery in active infective endocarditis (IE) has been reported. The drawback of early surgery is the risk that residual bacteria in the operative field may cause IE recurrence. Little is known regarding the relationship between intraoperative valve culture and recurrence. In the present study, we investigated the value of early surgery for IE based on the results of valve cultures. Hypothesis: Positive intraoperative valve cultures in early surgery are associated with recurrence. Methods: Between 2009 and 2017, 585 patients underwent valve surgery for definitive left-sided active IE at 14 affiliated hospitals. Early surgery was defined as surgery within 14 days from diagnosis, and patients with unknown valve culture results were excluded. We analyzed the short and mid-term outcome in patients with early surgery (n=228). These 228 patients were compared in two groups: positive (Group P, n=106) and negative (Group N, n=122) valve cultures. The primary outcome was all-cause mortality. Secondary outcomes were recurrence of IE. Mean follow-up time was 2.5±2.8 years. Results: Patients in group P had a significantly higher inflammatory response on preoperative blood tests (White blood cell count: 10.4 (8.3-14.5) vs. 8.2 (6.0-12.7) х10 3 /μl, p=0.005, C-reactive protein: 7.3 (3.8-11.0) vs. 3.8 (2.1-6.8) mg/dl, p<0.001). Patients in group P also had a significantly shorter duration from diagnosis to surgery (2 (1-4) vs. 4 (1-9) days, p<0.001). There was no significant difference in in-hospital mortality between the two groups (13/106 (12%) vs. 11/122 (9%), p=0.43). The overall survival rate at 1 and 5 years was 83% and 69% in group P, 82% and 75% in group N, respectively (p=0.85). The rate of freedom from the recurrence of endocarditis at 1 and 5 years postoperatively was 97% and 82% in group P, and 98% and 92% in group N, respectively (p=0.02). In Cox's hazard analysis, positive valve culture was a risk factor for IE recurrence in multivariate analysis (hazard ratio, 3.39; 95% confidence interval, 1.07 to 10.67; p=0.037). Conclusions: Positive valve culture cases in early surgery for active IE have a significantly increased risk of recurrence compared with valve culture-negative cases and require careful management.