Key result
Extensive infective endocarditis was associated with lower 5-year survival compared to non-extensive disease (60% vs 71%, p=0.029), despite similar 30-day mortality.
Why the study?
Extensive infective endocarditis involving the valve annulus or intervalvular fibrous body is a treatment challenge, prompting the need to clarify surgical outcomes.
Does surgery for extensive infective endocarditis compared to non-extensive infective endocarditis result in different mortality and complication rates?
Cohort (n=197)
No
Does surgery for extensive infective endocarditis compared to non-extensive infective endocarditis result in different mortality and complication rates?
Absolute Event Rate: 60% vs 71%
p-value: p=0.029
Surgery for extensive infective endocarditis has comparable early mortality to non-extensive cases, though midterm survival is lower and the need for permanent pacemakers is significantly higher.
Surgical outcomes for extensive IE with annular/IFB involvement were described in one center; leaves open generalizability and optimal strategies for this high-risk group.
OBJECTIVE: Extensive infective endocarditis (EIE) involving the valve annulus or the intervalvular fibrous body (IFB) is a treatment challenge. We sought to clarify the outcomes of patients undergoing surgery for EIE. METHODS: We retrospectively reviewed all 197 consecutive patients who underwent an operation for infective endocarditis (IE) between 2005 and 2016 in the Helsinki University Hospital. Thirty-five (18%) patients had EIE, of which 17 (9%) infection extended to IFB. RESULTS: Patients with EIE had higher EuroSCORE II (24.4% vs. 12.4% p < .001), higher frequency of diabetes (29% vs. 13% p = .017), more often NYHA Class IV (83% vs. 56% p = .02), aortic (97% vs. 45% p < .001), multivalve (40% vs. 11% p < .001), and prosthetic valve IE (37% vs. 9% p < .001), and underwent more often emergency surgery (46% vs. 29% p = .042). Thirty-day mortality was 9% in the EIE group and 7% in the non-EIE group (p = .720). Survival of patients with EIE at 5 years was 60% and with non-EIE 71% (p = .029). The frequency of complications was higher in EIE (54%) than in non-EIE patients (25%) (p < .001), due to the higher need for permanent pacemaker implantations (34% vs. 4% p < .001). Freedom from re-operations at 5 years was 91% in the EIE group and 97% in the non-EIE group (p = .203). CONCLUSIONS: Early mortality of surgery for EIE was comparable with non-EIE. Midterm survival was lower after surgery for EIE than after surgery for non-EIE but there was no difference in survival of patients with IE limited to the valve annulus amenable to patch repair and patients with endocarditis requiring IFB reconstruction.
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Huuskonen et al. (2021) conducted a cohort in Infective endocarditis (n=197). Extensive infective endocarditis (EIE) vs. Non-extensive infective endocarditis was evaluated on 5-year survival (p=0.029). Extensive infective endocarditis was associated with lower 5-year survival compared to non-extensive disease (60% vs 71%, p=0.029), despite similar 30-day mortality.
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