Key result
In patients undergoing surgery for infective endocarditis, early mortality was 8%, with active IE, preoperative dialysis, previous CABG, root abscess, and multivalve involvement as predictors.
Cohort (n=801)
No
Surgery for infective endocarditis carries an 8% early mortality rate, with active infection and multivalve involvement being significant predictors of poor early outcomes, though long-term survival is satisfactory for early survivors.
Research meaning:* Since it's a cohort study (Level 3), it *extends.
OBJECTIVES: Infective endocarditis (IE) remains a life-threatening disease, despite the improvement in diagnostic and therapeutic measures. We reviewed our outcomes for all adults who underwent surgery for endocarditis at our centre. METHODS: Between January 1995 and December 2013, 801 patients [586 men (73%)] underwent surgery for IE. Mean age was 60 ± 14.7 years. Native endocarditis (NE) was present in 372 patients (46%), and 379 (47%) patients had active IE. The mean follow-up period was 4.6 ± 4.75 years (maximum 20 years). RESULTS: Single-valve endocarditis was present in 551 (69%) patients (392 aortic and 159 mitral). Multivalve involvement was present in 250 (31%) patients. Preoperative stroke was present in 149 (19%) patients, while 62 (8%) patients were on dialysis prior to surgery. Valve repair was possible in 122 (15%) patients, while 679 (85%) patients underwent valve replacement. Mechanical valves were used in 312 (39%) patients. Aortic homografts were used in 84 (10%) patients. Early mortality occurred in 64 (8%) patients. Overall survival at 5, 10 and 20 years was 68%, 45% and 8.4%, respectively. Postoperative stroke occurred in 16 (2%) patients, while 59 (7%) patients required new dialysis postoperatively. Multivariate analysis revealed active IE (P = 0.002), preoperative dialysis (P = 0.007), previous coronary artery bypass grafting (P = 0.001), root abscess (P = 0.006) and tricuspid valve or multivalve involvement (P = 0.002) to be predictors of early mortality. The need for dialysis (P < 0.001), previous coronary artery bypass grafting (P < 0.001) and mitral valve (P = 0.002) and tricuspid valve/multivalve involvement (P < 0.001) were significant predictors of late mortality. CONCLUSIONS: Active IE is associated with high perioperative mortality especially with multivalve and aortic root involvement. Preoperative stroke has no impact on perioperative mortality. Long-term survival for those who survived the immediate postoperative period is satisfactory, and mechanical valves are associated with the best long-term survival.
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Said et al. (2017) conducted a cohort in Infective endocarditis (n=801). Surgery for infective endocarditis was evaluated on Early mortality. In patients undergoing surgery for infective endocarditis, early mortality was 8%, with active IE, preoperative dialysis, previous CABG, root abscess, and multivalve involvement as predictors.
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