Early and intermediate outcomes for surgical management of infective endocarditis

Lindsay Volk,Nina Verghis,Antonio Chiricolo,Anthony Lemaire,Leonard Y Lee,Hirohisa Ikegami

doi:10.1186/s13019-019-1029-1

Abstract

ObjectiveThe treatment of active infective endocarditis (IE) presents a clinical dilemma with uncertain outcomes. This study sets out to determine the early and intermediate outcomes of patients treated surgically for active IE at an academic medical center.MethodsA retrospective chart review was conducted to identify patients who underwent surgical intervention for IE at our institution from July 1st, 2011 to June 30th, 2018. In-patient records were examined to determine etiology of disease, surgical intervention type, postoperative complications, length of stay (LOS), 30-day in-hospital mortality, and 1-year survival.ResultsTwenty-five patients underwent surgical intervention for active IE. The average age of the patients was 47 ± 14 years old and most of the patients were male (N = 15). The majority of the patients had the mitral valve replaced (N = 10), with the remaining patients having tricuspid (N = 8) and aortic (N = 7) valve replacements. The etiology varied and included intravenous drug use (IVDU), and presence of transvenous catheters. The 30-day in-hospital mortality was 4% with 1 patient death and the 1-year survival was 80%. The average LOS was 27 days ±15 and the longest LOS was 65 days.ConclusionsSurgical management of IE can be difficult and challenging however mortality can be minimized with acceptable morbidity. The most common complication was CVA. The average LOS is longer than traditional adult cardiac surgery procedures and the recurrence rate of valvular infection is not minimal especially if the underlying etiology is IVDU.

Highlights

Infective endocarditis (IE) is a rare disease, but its impact is significant [1]
The most common complication of this disease process is congestive heart failure, septic shock, embolic events leading to strokes and other neurologic events [12]
This study demonstrates that while the treatment of IE is complex, the morbidity and mortality rates can be minimized to an acceptable level

Summary

Introduction

Infective endocarditis (IE) is a rare disease, but its impact is significant [1]. It affects 3 to 10 per 100,000 per year in the population at large and the studies suggest that the incidence is rising [2]. Despite recent advances in treatment, IE remains a life-threatening disease with significant morbidity and mortality [3, 4]. As a complement to the medical management of IE, surgery remains a treatment option for some of the patients with IE. The surgical treatment of active infectious endocarditis has an associated high mortality and morbidity [4].

Methods

Results

Discussion

Conclusion