Skip to main content

Advertisement

SpringerLink
Log in

Surgery for infective endocarditis—analysis of factors affecting outcome

  • Original Article
  • Published:
Indian Journal of Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

Abstract

Purpose

Despite advances in medical care, infective endocarditis (IE) has high mortality. Surgery for IE though recommended for complications of the disease is still not commonly offered due to conflicting reports in the literature. We reviewed our results of surgery for IE from the last 5 years to assess their outcome.

Methods

A retrospective review from a single center of consecutive patients who underwent surgery for infective endocarditis from September 2014 to December 2019 was done. Data was collected from hospital records and follow-up done up to May 2020. Outcomes evaluated were mortality, follow-up survival, and postoperative complications. Factors affecting mortality and survival were analyzed.

Results

Ninety-seven patients underwent surgery for IE during this period. Seventy-nine had native valve endocarditis (NVE) and 18 had prosthetic valve endocarditis (PVE). The overall postoperative mortality was 13%, with mortality for native valve endocarditis being 11% and that for prosthetic valve endocarditis being 22%, which was not statistically significant. Three-year survival for the overall group was 88.7% with 88.1% for NVE and 91.7% for PVE. Multivariate predictors of operative mortality were a high EuroSCORE II, diabetes mellitus, and the presence of Staphylococcus organism.

Conclusion

Surgery for infective endocarditis has a very acceptable early outcome and intermediate-term survival.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Vincent LL, Otto CM. Infective endocarditis: update on epidemiology, outcomes, and management. Curr Cardiol Rep. 2018;20:86.

    Article  Google Scholar 

  2. Cabell CH, Jollis JG, Peterson GE, et al. Changing patient characteristics and the effect on mortality in endocarditis. Arch Intern Med. 2002;162:90–4.

    Article  Google Scholar 

  3. Wang A, Gaca JG, Chu VH. Management considerations in infective endocarditis: a review. JAMA. 2018;320:72–83.

    Article  Google Scholar 

  4. Cresti A, Chiavarelli M, Scalese M, et al. Epidemiological and mortality trends in infective endocarditis, a 17-year population-based prospective study. Cardiovasc Diagn Ther. 2017;7:27–35.

    Article  Google Scholar 

  5. Pant S, Patel NJ, Deshmukh A, et al. Trends in infective endocarditis incidence, microbiology, and valve replacement in the United States from 2000 to 2011. J Am Coll Cardiol. 2015;65:2070–6.

    Article  Google Scholar 

  6. Tleyjeh IM, Abdel-Latif A, Rahbi H, et al. A systematic review of population-based studies of infective endocarditis. Chest. 2007;132:1025–35.

    Article  Google Scholar 

  7. Kang DH, Lee S, Kim YJ, et al. Long-term results of early surgery versus conventional treatment for infective endocarditis trial. Korean Circ J. 2016;46:846–50.

    Article  Google Scholar 

  8. Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC Guideline for the Management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2017;70:252-289.

  9. Manne MB, Shrestha NK, Lytle BW, et al. Outcomes after surgical treatment of native and prosthetic valve infective endocarditis. Ann Thorac Surg. 2012;93:489–93.

    Article  Google Scholar 

  10. David TE, Gavra G, Feindel CM, Regesta T, Armstrong S, Maganti MD. Surgical treatment of active infective endocarditis: a continued challenge. J Thorac Cardiovasc Surg. 2007;133:144–9.

    Article  Google Scholar 

  11. Edlin P, Westling K, Sartipy U. Long-term survival after operations for native and prosthetic valve endocarditis. Ann Thorac Surg. 2013;95:1551–6.

    Article  Google Scholar 

  12. Li JS, Sexton DJ, Mick N, et al. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis. 2000;30:633–8.

    Article  CAS  Google Scholar 

  13. STS Adult Cardiac Surgery Database Data Specifications version 4.20.2.Year 2020 page 176.

  14. Kieser TM, Rose MS, Head SJ. Comparison of logistic EuroSCORE and EuroSCORE II in predicting operative mortality of 1125 total arterial operations. Eur J Cardiothorac Surg. 2016;50:509–18.

    Article  Google Scholar 

  15. Mehta RL, Kellum JA, Shah SV, et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care. 2007;11:R31.

    Article  Google Scholar 

  16. Prendergast BD, Tornos P. Surgery for infective endocarditis: who and when? Circulation. 2010;121:1141–52.

    Article  Google Scholar 

  17. Wang A, Pappas P, Anstrom KJ, et al. The use and effect of surgical therapy for prosthetic valve infective endocarditis: a propensity analysis of a multicenter, international cohort. Am Heart J. 2005;150:1086–91.

    Article  Google Scholar 

  18. Wang A, Athan E, Pappas PA, et al. Contemporary clinical profile and outcome of prosthetic valve endocarditis. JAMA. 2007;297:1354–61.

    Article  CAS  Google Scholar 

  19. Madeira S, Rodrigues R, Tralhão A, et al. Assessment of perioperative mortality risk in patients with infective endocarditis undergoing cardiac surgery: performance of the EuroSCORE I and II logistic models. Interact Cardiovasc Thorac Surg. 2016;22:141–8.

    Article  Google Scholar 

  20. Slipczuk L, Codolosa JN, Davila CD, et al. Infective endocarditis epidemiology over five decades: a systematic review. PLoS One. 2013;8:e82665.

    Article  Google Scholar 

  21. DeSimone DC, Tleyjeh IM, Correa de Sa DD, et al. Temporal trends in infective endocarditis epidemiology from 2007 to 2013 in Olmsted County, MN. Am Heart J. 2015;170:830–6.

    Article  Google Scholar 

  22. Marushchak O, Cole H, Hiebert B, et al. Analysis of short- and long-term outcomes of patients with surgically treated left-sided infective endocarditis: a 5-year longitudinal follow-up study. Semin Thorac Cardiovasc Surg. 2017;29:311–20.

    Article  Google Scholar 

  23. Thuny F, Grisoli D, Collart F, Habib G, Raoult D. Management of infective endocarditis: challenges and perspectives. Lancet. 2012;379:965–75.

    Article  Google Scholar 

  24. Zegdi R, Debièche M, Latrémouille C, et al. Long-term results of mitral valve repair in active endocarditis. Circulation. 2005;111:2532–6.

    Article  Google Scholar 

  25. Toyoda N, Itagaki S, Egorova NN, et al. Real-world outcomes of surgery for native mitral valve endocarditis. J ThoracCardiovasc Surg. 2017;154:1906–1912.e9.

    Google Scholar 

  26. Harky A, Hof A, Garner M, Froghi S, Bashir M. Mitral valve repair or replacement in native valve endocarditis? Systematic review and meta-analysis. J Card Surg. 2018;33:364–71.

    Article  Google Scholar 

  27. Yanagawa B, Elbatarny M, Verma S, et al. Surgical management of tricuspid valve infective endocarditis: a systematic review and meta-analysis. Ann Thorac Surg. 2018;106:708–14.

    Article  Google Scholar 

  28. Vikram HR, Buenconsejo J, Hasbun R, Quagliarello VJ. Impact of valve surgery on 6-month mortality in adults with complicated, left-sided native valve endocarditis: a propensity analysis. JAMA. 2003;290:3207–14.

    Article  CAS  Google Scholar 

  29. Cabell CH, Abrutyn E, Fowler VG Jr, et al. Use of surgery in patients with native valve infective endocarditis: Results from the International Collaboration on Endocarditis Merged Database. Am Heart J. 2005;150:1092–8.

    Article  Google Scholar 

  30. Aksoy O, Sexton DJ, Wang A, et al. Early surgery in patients with infective endocarditis: a propensity score analysis. Clin Infect Dis. 2007;44:364–72.

    Article  Google Scholar 

  31. Tleyjeh IM, Ghomrawi HMK, Steckelberg JM, et al. The impact of valve surgery on 6-month mortality in left-sided infective endocarditis. Circulation. 2007;115:1721–8.

    Article  Google Scholar 

  32. Sy RW, Bannon PG, Bayfield MS, Brown C, Kritharides L. Survivor treatment selection bias and outcomes research: a case study of surgery in infective endocarditis. Circ Cardiovasc Qual Outcomes. 2009;2:469–74.

    Article  Google Scholar 

  33. Bannay A, Hoen B, Duval X, et al. The impact of valve surgery on short- and long-term mortality in left-sided infective endocarditis: do differences in methodological approaches explain previous conflicting results? Eur Heart J. 2011;32:2003–15.

    Article  Google Scholar 

  34. Lalani T, Cabell CH, Benjamin DK, et al. Analysis of the impact of early surgery on in-hospital mortality of native valve endocarditis: use of propensity score and instrumental variable methods to adjust for treatment-selection bias. Circulation. 2010;121:1005–13.

    Article  Google Scholar 

  35. Mourvillier B, Trouillet JL, Timsit JF, et al. Infective endocarditis in the intensive care unit: clinical spectrum and prognostic factors in 228 consecutive patients. Intensive Care Med. 2004;30:2046–52.

    Article  Google Scholar 

Download references

Acknowledgments

We thank Ms. Greeshma Ravindran, Assistant Professor, Department of Biostatistics for help with the statistical analysis for this study.

Funding

None.

Author information

Authors and Affiliations

  1. Department of Cardiovascular & Thoracic Surgery Amrita Institute of Medical Sciences and Research Center, Amrita Vishwa Vidyapeetham (Amrita University), Ponnekara PO, Kochi, Kerala, 682041, India

    Kirun Gopal, Neethu Krishna & Praveen Kerala Varma

Authors
  1. Kirun Gopal
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Neethu Krishna
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Praveen Kerala Varma
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kirun Gopal.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

Institutional Review Board (IRB) approval was obtained for the study and the board waived individual written patient consent for the study (IRB number IRB-AIMS-2020-234 dated 18/8/2020).

Informed consent

Not required.

Statement of human and animal rights

There was no infringement of human/animal rights.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gopal, K., Krishna, N. & Varma, P.K. Surgery for infective endocarditis—analysis of factors affecting outcome. Indian J Thorac Cardiovasc Surg 37, 381–391 (2021). https://doi.org/10.1007/s12055-021-01137-w

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12055-021-01137-w

Keywords

Search

Navigation