Perioperative management of patients with infective endocarditis complicated by acute heart failure

Annotation. The article presents the results of a retrospective analysis, which included clinical data from 311 patients with infective endocarditis over the period from January 1, 2019, to October 22, 2021, at the “M.M. Amosov National Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine”. Clinical and laboratory data, as well as echocardiographic examination results, were recorded and statistically processed using STATISTICA 12.6. An algorithm for diagnostic and therapeutic measures was developed for patients with infective endocarditis presenting signs of acute heart failure during the perioperative period. The presence of vegetations on left heart valves on echocardiography, an end-diastolic index greater than 94.3 ml/m², an end-systolic index greater than 40.5 ml/m², a pulmonary artery pressure above 50 mm Hg, and a baseline NT-proBNP level over 7473.7 pg/ml were identified as independent indicators for admission to the intensive care unit and the need for urgent cardiac surgical intervention. Intraoperative hemosorption demonstrated that in-hospital mortality in the group without hemosorption was higher than in the group where hemosorption was used, with 4 (5.3%) and 1 (3.9%) patients, respectively. The results of the developed perioperative protocol for treating patients with infective endocarditis complicated by acute heart failure suggest it may be recommended for implementation in healthcare facilities.