Single Centre Review of Surgically Managed Infective Endocarditis

Abstract

Purpose: Infective endocarditis (IE) is a life-threatening illness that requires early intervention. We sought to identify the outcomes of all patients who underwent surgical intervention for IE at an Australian tertiary hospital. Methodology: The study institution's Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) database was searched for all patients who underwent valve surgery with active IE between 2000 and 2015. Additional data was obtained by reviewing medical records. Results: There were 133 patients who underwent surgical management of IE. Mean patient age was 54 ± 16 years. A history of IV drug use was present in 23% (31/133) of patients. The commonest infective agents were Staphylococcus aureus in 32% (42/133), of which 14% were MRSA (6/42), Streptococcus viridans in 15% (20/133), and Enterococcus faecalis in 13% (17/133). A single valve procedure was performed in 75% (100/133), while multiple valve procedures were performed in 25% (33/133). The surgical procedures were: aortic valve surgery in 68% (90/133), mitral valve surgery in 47% (63/133) and tricuspid valve surgery in 10% (13/133). Surgical mortality was 15% (20/133). On univariate analysis having emergency surgery (p = 0.003), cross clamp time (p = 0.015) and cardiopulmonary bypass time (p = 0.03) were identified as significant risk factors for mortality. On multivariable analysis emergency surgery (p = 0.021) was identified as a significant risk factor for mortality. Conclusion: Surgery for infective endocarditis is associated with substantial early mortality. Emergency surgery is associated with increased risk of mortality. A multidisciplinary approach with early referral to cardiothoracic surgery is indicated.