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Factors associated with surgery for active endocarditis in congenital heart disease

Tomoaki Murakami1, Koichiro Niwa, Masao Yoshinaga

  • 1Department of Adult Congenital Heart Disease and Pediatrics, Chiba Cardiovascular Center, Ichihara City, Japan. murat@seagreen.ocn.ne.jp

International Journal of Cardiology
|December 24, 2010
PubMed

Insights

Surgery is recommended for active infective endocarditis (IE) in congenital heart disease patients with heart failure, perivalvular abscess, or antibiotic changes. These factors independently predict the need for surgical intervention in this vulnerable population.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Infectious Diseases

Background:

  • Establishing surgical indications for active infective endocarditis (IE) in congenital heart disease (CHD) patients is challenging due to limited case numbers.
  • Recent advancements in cardiac surgery necessitate clearer guidelines for intervention during active IE in CHD.

Purpose of the Study:

  • To determine the specific indications for surgical intervention in patients with congenital heart disease experiencing active infective endocarditis.
  • To identify independent predictors for surgical treatment in this patient cohort.

Main Methods:

  • A multi-center, retrospective observational cohort study involving 239 patients with infective endocarditis and congenital heart disease from 1997-2001 in Japan.
  • Surgical therapy for active IE was defined as cardiac surgery during intravenous antibiotic administration; 61 patients (26%) underwent this intervention.

Main Results:

  • Univariate analysis identified lack of pre-existing cardiac diagnosis, aortic valve IE, perivalvular abscess, heart failure, and antibiotic changes as associated with surgical need.
  • Stepwise logistic regression revealed perivalvular abscess, heart failure, and antibiotic changes as independent determinants for surgical treatment in active IE with CHD.

Conclusions:

  • Surgical intervention should be strongly considered for active infective endocarditis in congenital heart disease patients presenting with heart failure.
  • The presence of a perivalvular abscess or the need for antibiotic modification are critical indicators for surgical consideration in active IE within this population.
Abstract

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