Endocarditis Through the Ages-What Has Changed During the Past Two Decades

Area of Science:

• Cardiology
• Cardiac Surgery
• Infectious Diseases

Background:

• Native valve endocarditis (NVE) treatment has seen advancements, including multidisciplinary teams and improved perioperative care.
• Despite these developments over the past two decades, significant improvements in patient outcomes have not been observed.
• This study aims to compare outcomes between contemporary and historic cohorts of NVE patients undergoing cardiac surgery.

Purpose of the Study:

• To compare the clinical characteristics, treatment approaches, and outcomes of patients with native valve endocarditis (NVE) between a historic and a contemporary cohort.
• To evaluate the impact of evolving patient demographics, disease presentation, and surgical techniques on NVE patient outcomes.
• To assess long-term survival rates in NVE patients across different treatment eras.

Main Methods:

• Retrospective observational single-center study comparing two cohorts of patients undergoing first-time cardiac surgery for NVE.
• Historic cohort (1998-2003) and contemporary cohort (2021-2024) were analyzed.
• Data collected included patient demographics, preoperative clinical presentation, surgical procedures, postoperative complications, and survival rates.

Main Results:

• The annual caseload for NVE surgery significantly increased in the contemporary cohort.
• Contemporary patients were older, had higher BMI, and presented with worse preoperative conditions, including increased septic embolizations and acute kidney injury.
• Despite a higher rate of minimally invasive procedures in the contemporary group, they experienced increased postoperative dialysis, longer ICU stays, and higher perioperative mortality, though 1-year survival remained comparable.

Conclusions:

• Contemporary patients undergoing surgery for native valve endocarditis (NVE) present with significantly higher risk profiles and increased caseloads.
• These factors contribute to greater postoperative morbidity and mortality in the contemporary cohort.
• Despite increased short-term complications, long-term survival rates at one year have remained stable between the historic and contemporary NVE patient groups.