Abstract
Infective endocarditis represents a surgical challenge associated with perioperative mortality. The aim of this study is to evaluate the predictors of operative mortality and long-term outcomes in high-risk patients. We retrospectively analyzed 123 patients operated on for infective endocarditis from January 2011 to December 2020. Logistic regression model was used to identify prognostic factors of in-hospital mortality. Long term follow-up was made to asses late prognosis. Preoperative renal failure, an elevation EuroSCORE II and prior aortic valve re-replacement were found to be preoperative risk factors significantly associated with mortality. In-hospital mortality was 27% in patients who had previously undergone aortic valve replacement (n = 4 out of 15 operated, p = 0.01). Patients who were operated on during the active phase of infective endocarditis showed a higher mortality rate than those operated on after the acute phase (16% vs. 0%; p = 0.02). The type of prosthesis used (biological or mechanical) was not associated with mortality, whereas cross-clamp time significantly correlated with mortality (mean cross-clamp time 135 ± 65 min in dead patients vs. 76 ± 32 min in surviving patients; p = 0.0005). Mean follow up was 57.94 ± 30.9 months. Twelve patients died (11.65%). Among the twelve mortalities, five were adjudicated to cardiac causes and seven were non-cardiac (two cancers, one traumatic accident, one cerebral hemorrhage, two bronchopneumonia, one peritonitis). Overall survival probability (freedom from death, all causes) at 3, 5, 7 and 8 years was 98.9% (95% CI 97–100%), 96% (95% CI 92–100%), 85.9% (95% CI 76–97%), and 74% (95% CI 60–91%) respectively. Our study demonstrates that an early surgical approach may represent a valuable treatment option for high-risk patients with infective endocarditis, also in case of prosthetic valve endocarditis. Although several risk factors are associated with higher mortality, no patient subset is inoperable. These findings can be helpful to inform decision-making in heart team discussion.
Highlights
Infective endocarditis represents a surgical challenge associated with perioperative mortality
Many patients considered at intermediate-to-high risk or inoperable that have undergone transcatheter aortic valve replacement are susceptible to infective endocarditis on these p rostheses[1,2]
Preoperative renal failure, EuroSCORE II and prior aortic valve replacement were found to be significantly associated with mortality
Summary
Infective endocarditis represents a surgical challenge associated with perioperative mortality. Several risk factors are associated with higher mortality, no patient subset is inoperable. These findings can be helpful to inform decision-making in heart team discussion. Many patients considered at intermediate-to-high risk or inoperable that have undergone transcatheter aortic valve replacement are susceptible to infective endocarditis on these p rostheses[1,2]. Prosthetic models and anesthetic management have constantly improved over the last y ears[3], the increasing number of patients at higher risk for surgery may affect operative success, in terms of higher mortality. The aim of this study is to evaluate predictors of operative mortality and mid-long term outcomes in highrisk patients with endocarditis
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