Key result
Surgery for infective endocarditis in congenital heart disease achieves ~81% 20-year survival.
Cohort (n=96)
Surgical treatment for infective endocarditis in children and adults with congenital heart disease yields low in-hospital mortality (6.3%), favorable 20-year survival (80.5%), and rare recurrence (3.6% at 20 years), though emergency surgery and gram-negative bacterial infections significantly increase mortality risk.
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May inform preoperative risk assessment in congenital heart disease endocarditis; extends observational survival data but should not yet change practice.
OBJECTIVE: Reports describing surgery for infective endocarditis (IE) in children and adults with congenital heart disease (CHD) are limited. This study aimed to determine the patient characteristics, preoperative conditions, surgical outcomes, and risk factors in this cohort. METHODS: All children and adults with CHD who underwent surgical treatment for IE between 2001 and 2024 were reviewed. Patient characteristics and surgical procedures were evaluated; survival, recurrent IE, and risk factors were analyzed. RESULTS: A total of 96 patients underwent surgical treatment for IE, including 52 children and 44 adults with CHD. Underlying CHD included ventricular septal defect in 31 patients, aortic stenosis/insufficiency in 26, and tetralogy of Fallot in 14. The most frequently infected lesion was the aortic valve in 40 patients, and the most frequently detected organism was Staphylococcus species in 34 patients. Vegetation was observed in 65 patients. Median age at surgery was 17.2 (IQR: 11.7-29.4) years. In-hospital mortality was 6.3%, and survival at 5, 10, and 20 years was 90.6, 88.1, and 80.5%, respectively. Freedom from recurrent IE was 96.4% at 20 years. Number of previous operations (hazard ratio (HR): 1.585, p=0.005), gram-negative bacteria (HR: 11.475, p<0.001), emergency operations (HR: 17.988, p=0.001), and longer aortic cross-clamp time (HR: 1.011, p=0.043) were risk factors for mortality. CONCLUSIONS: In children and adults with CHD, mortality following surgery for IE was low, and recurrent IE was rare. Individualized management based on the patient's preoperative condition and the causative organism appears to be important for improving survival.
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Schaeffer et al. (2026) conducted a cohort in Infective endocarditis in congenital heart disease (n=96). Surgical treatment for infective endocarditis was evaluated on Survival at 20 years. Surgical treatment for infective endocarditis in congenital heart disease yielded 6.3% in-hospital mortality, 80.5% 20-year survival, and 96.4% freedom from recurrent endocarditis at 20 years.
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