The Role of Surgery in Contemporary Infective Endocarditis

Infective endocarditis (IE) is a multifaceted disease and its treatment can often be challenging. Furthermore, along with a rising incidence, the clinical manifestation of IE has changed over the years. This study analyses the interdisciplinary endocarditis team management of IE in a tertiary care hospital.

We reviewed the patients who were admitted for IE at our institution between January 2012 and December 2021. Risk estimation was performed by calculating the EuroSCORE II and the EndoSCORE.

A total of 812 consecutive patients were admitted to our centre for IE. Among these patients, 249 patients (30.7%) underwent conservative treatment for IE (Group C) and 563 patients (69.3%) underwent surgery (Group S). The EuroSCORE II was 5.5 (2.6-10.1) in Group C and 5.1 (2.5-10.7) in group S, whereas the EndoSCORE was 7.6 (6.9-19.6) in Group C and 12.3 (6.9-19.5) in Group S. The Duke criteria were not met in 297 patients (36.6%) and patients not meeting the Duke criteria were more often treated conservatively. A higher number of patients suffering from TAVR-endocarditis and tricuspid valve endocarditis were treated conservatively. Whereas patients with aortic valve endocarditis were treated surgically more often.

Infective endocarditis is a multifaceted disease, which requires a specialized interdisciplinary approach. Decisions on treatment modalities should be made on a case-to-case basis in an endocarditis team setting. In addition to treatment modality, adequate consideration should be given to the pathogen causing IE and the extent of IE.