EARLY VALVE SURGERY SIGNIFICANTLY REDUCES PERIOPERATIVE MORTALITY IN INFECTIVE ENDOCARDITIS – 22 YEARS EXPERIENCE

Abstract

Background: Acute infective endocarditis is associated with high morbidity and mortality, and optimal timing of surgical treatment in current guidelines is still unclear. We performed retrospective analysis to compare early valve surgery with postponed surgery after full 6 weeks course of antibiotics to 30 day in hospital mortality. Methods: From Jan 1995 to Sept 2017, 224 patients were operated because of IE in our institution. Late valve surgery was considered standard treatment for IE in a period from 1995 to 2007, but after comprehensive review of literature early valve surgery treatment was decided by consensus of a multidisciplinary team made by cardiac surgeons and infective disease specialists. Late valve surgery was defined as replacement or repair of infected valve after the resolution of the infection to reduce the risk of operation and of relapse of IE. Early valve surgery was introduced to reduce the risk of embolization, progressive deterioration of cardiac function, which can result in more difficult repair, progressive cardiogenic shock and organ failure, thus increased mortality. Results: Total of 224 patients in a period from 1995 to 2017 was eligible for analysis. Overall 65 (29, 1%) vs 179 (79.9 %) patients underwent late valve surgery (LVS) vs early valve surgery (EVS), respectively. Average logistic mortality was 16.4%, EuroSCORE II 7.77% for patients underwent LVS vs 18.3%, EuroSCORE II 9.32% for patients in EVS group. Total in hospital mortality was 28/244 (11, 47%). In EVS group, we observed significantly lower mortality vs LVS group, 16/179 (8, 67%) vs 12/65 (18, 46%), P .038, respectively. Conclusion: The results of this retrospective analysis suggests that compared with conventional treatment with the completion of a full therapeutic course of antibiotics, early surgical intervention is associated with significantly lower risk of in hospital mortality in patients with acute infective endocarditis. Our observations are accordant with 2015 ESC Guidelines for the management of infective endocarditis.