Surgical Treatment of Infective Endocarditis: Prognostic Factors, Outcomes, Main Trends (25-Years Single Center Study)

Dmitry V. Griaznov ¹, Sergey A. Kovalev ¹, Andrey V. Bulynin ¹, Alexander N. Kinshov ²

¹ Voronezh Regional Clinical Hospital No1, Voronezh Burdenko State Medical University , Voronezh, Russia; ² Voronezh Burdenko State Medical University, Voronezh, Russia;

Date, time and location: 2018.05.26 15:30, Congress Hall, 2F–B

Abstract

Objective. The aim was to summarize the results of surgical treatment of infective endocarditis (IE) including evaluation of short- and long-term results, determination of predictors of morbidity and mortality, study of temporal trends.

Methods. The data of 572 patients with IE, treated surgically over last 25 years. Epidemiological, clinical, instrumental, laboratory and surgical criteria were analyzed. A number of events was estimated, i.a: embolism, mortality, freedom from complications, long-term survival. 2 periods: 1993-2004 and 2005-2017 were compared.

Results. Left-sided (LS) IE: 30-day mortality was 9.8%. Survival in 2 years was 83,4±2,5% and in 5 years - 73,8±4,4%. 2 years freedom from reoperation was96,6±1,5%. The main predictor of embolism in LSIE was large vegetations size (p<0.005). No cases of hospital mortality in patients undergone MV repair were registered. Main risk factors of 30-days mortality were: severe heart failure (p=0.036); underlying valvular disease (p=0,014); renal failure (p=0.0001).

LSIE complicated with perivalvular infection (PI): 30-day mortality was 16.3% (p=0.025). 2 years survival - 73,9±8,4% (p=0.015), and in 5 years - 60,2±12,1% (p=0,048). In PI patients occurrence of embolism was higher (p=0,022). Freedom from reoperation in 2 years was 69,1±11,4% (p=0.019).

Right-sided IE: 30-day mortality was 0-3.14%. 2-years survival was92,8±4,1%. 5-years survival -81,7±10,0%.

In period 2005-2017 in comparison with 1993-2004 the incensement of next hallmarks was found: number of patients (p<0.0001); age of patients (p=0.003); number of females (p=0.019); incidence of perivalvular lesions (p=0.049); number of valve repairs (p=0.008). The decrease of following data was observed: incidence of early prosthetic valve IE (p=0.021); in-hospital mortality (p=0.023).

Conclusions. In many cases of IE poor prognosis can be improved by surgery. The most complicated form is secondary LSIE with PI and organ failure. Finding factors affecting the outcome can lead to positive impact on the results of IE treatment.