Outcomes of surgery for extensive infective endocarditis

Area of Science:

• Cardiovascular Surgery
• Infectious Diseases
• Cardiac Surgery Outcomes

Background:

• Extensive infective endocarditis (EIE) involving the valve annulus or intervalvular fibrous body (IFB) presents significant surgical challenges.
• Understanding the outcomes of surgical interventions for EIE is crucial for patient management and treatment planning.

Purpose of the Study:

• To evaluate and clarify the surgical outcomes for patients diagnosed with extensive infective endocarditis (EIE).
• To compare the results of EIE surgery with those of non-EIE cases.

Main Methods:

• Retrospective review of 197 patients undergoing surgery for infective endocarditis (IE) between 2005 and 2016.
• Analysis of 35 patients with EIE, including 17 with IFB involvement, compared to non-EIE patients.
• Data collected included clinical characteristics, surgical details, mortality, survival rates, complications, and re-operations.

Main Results:

• EIE patients exhibited higher risk scores (EuroSCORE II), more comorbidities (diabetes), and more severe disease (NYHA Class IV, multivalve, prosthetic valve IE, emergency surgery).
• Thirty-day mortality was similar between EIE (9%) and non-EIE (7%) groups.
• Five-year survival was lower for EIE patients (60%) compared to non-EIE (71%). Complications, particularly pacemaker implantations, were higher in the EIE group (54% vs. 25%).

Conclusions:

• Surgical treatment for EIE has comparable early mortality to non-EIE.
• Midterm survival is reduced in EIE patients post-surgery.
• Survival rates were similar for EIE patients undergoing patch repair versus those requiring IFB reconstruction.