Early Surgical Outcomes in Infective Endocarditis Before and During COVID-19 Pandemic.

Abstract

Infective endocarditis (IE) is associated with extremely high surgical mortality. During the SARS-CoV-2 pandemic, hospitals restructured their intensive care units and outpatient services to prioritize COVID-19 care, which may have affected the outcomes of patients requiring urgent procedures. This study aimed to evaluate the impact of the pandemic on surgical outcomes of IE patients in Southern Germany. This observational, community-based study compared two cohorts of surgical candidates: a pandemic cohort from March 2020 to November 2021 (n=84) and a pre-pandemic cohort from August 2018 to March 2020 (before the lockdown, n=94). Preoperative status and postoperative in-hospital complications were analyzed and compared between groups. The pandemic cohort experienced longer symptom onset to diagnosis intervals (14.5 vs. 8 days, p = 0.529). A higher incidence of definite IE was observed after the lockdown according to the modified Duke criteria (82.1% vs. 68.1%, p = 0.035). Patients presented with more severe symptoms post-lockdown (NYHA Class III: 50% vs. 33%; Class IV: 22.6% vs. 11.7%, p = 0.001). Postoperative complications, such as re-thoracotomy due to bleeding and hemofiltration for acute renal failure, were significantly more frequent after the lockdown (p < 0.05). However, in-hospital survival rates did not differ significantly between the groups. The COVID-19 pandemic and related lockdown measures were associated with delayed diagnoses and worse perioperative outcomes for surgical IE patients, highlighting the need for improved management strategies during public health crises.