Surgical management and outcomes of endocarditis in adolescents and adults with congenital heart disease

Background: Adolescents and adults with CHD have increased risk for IE because of anatomic anomalies and burden of intracardiac prosthetic material. There are significant challenges in determining primary surgical or medical management along with limited guidelines to determine management. Methods: A retrospective review was performed at both the University of Colorado Hospital and Children's Hospital Colorado of patients 12 years of age and older with CHD who were treated for IE between 2009 and 2019. Results: Of 138 cases, the most common CHD lesions were bicuspid aortic valve (30%) and tetralogy of Fallot (14%). Seventy percent of patients had intracardiac prosthetic material. Of the cases where valvular IE was verified, 51% involved prosthetic valves. Surgical management was pursued in 53% of patients with 7% mortality; 11% of patients did not have surgical management due to elevated perioperative risk with 53% mortality; the remaining patients had non-surgical management due to lack of severe features with 0% mortality. Overall mortality during the initial IE treatment course was 9%, with all-cause mortality of 15%. Recurrence occurred in 12% of patients with median follow-up time of 1.68 years. Conclusions: We report a large single-center study of IE in the adolescent and adult CHD population. Mortality and recurrence rates remain high in this population. We propose a preliminary algorithm for determining surgical management for IE, as well as potentials for future innovations.