Predictors of mortality in valvular infective endocarditis: A single-center study

Abstract

Background Valvular infective endocarditis (IE) may occur in association with either native or prosthetic valves, with great risk of mortality and morbidity. Surgical management is an essential part of the therapeutic process in these patients. Objectives This study aims at evaluation of early outcomes of surgically treated patients with native or prosthetic IE together with determining predictors of mortality. Patients and methods Outcomes of 60 patients who underwent surgery for native or prosthetic valve endocarditis at National Heart Institute during a 3-year period (April 2016 to March 2019) were studied prospectively. Preoperative, intraoperative, and postoperative data were tested as possible predictors for mortality. All patients were followed for at least 6 months after surgery. Results The hospital mortality rate was 11 (18.3%) patients, and total mortality rate after 6-month follow-up was 17 (28.3%) patients. Native valve endocarditis was present in 36 (60.0%) patients and prosthetic valve endocarditis in 24 (40.0%) patients. The commonest involved valve was mitral valve in 19 (31.7%) followed by aortic valve in 14 (23.3%). The commonest isolated organisms were Staphylococcus spp., which was found in 19 (31.6%) patients, followed by Streptococcus spp. and Gram negative bacteria, which were found in nine (15.0%) patients each. Mean Euro score II was 6.21 ± 2.54 in the surviving group. Duration of bypass time was 144.75 ± 35.81 min in dead patients and 104.56 ± 20.43 min in the surviving patients. Congestive heart failure, embolization, and periannular extension of infection were the most powerful predictors of in-hospital mortality. Periannular extension of infection was the most powerful predictor of 6-month mortality. Conclusion Surgery for IE is risky, especially in redo cases. Extensive infection carried the worst prognosis. Euro score II is a reliable indicator for hospital and early mortality. Valve repair can be performed in selected cases.