Surgical Treatment of INFECTIVE ENDOCARDITIS: Outcomes and Predictors of Mortality

Objectives: A retrospective analysis was conducted of the early and long-term results of surgical treatment in patients with infective endocarditis.

Methods: A total number of 239 patients who underwent surgery for IE at University Hospital Heidelberg from January 1993 to December 2013 were included in this retrospective study. The primary endpoint in the study cohort was survival at 30 days after surgical treatment in our institution. The secondary endpoints were perioperative clinical characteristics and adverse events, which could have an impact on early postoperative mortality. The demographic and perioperative variables of the 30-day survivors and non-survivors were compared with identify the predictors of 30-day overall mortality.

Results: The mean age of the entire population was 58.2 ± 15.2 years and 27.2% (n = 65) of the population were female. The mean follow-up was 2121 ± 2173 days (5.45 ± 5.80 years) with the longest follow-up of 7647 days (>20 years). The estimated overall survival of the patient cohort was 74.5% at 30 days, 66.1% at one year, 65.3% at two years, 64.0% at 5 years and 63.3% from 6 years to the end of the follow-up. There were no statistically significant differences with respect to preoperative demographics and several clinical baseline characteristics. However, non-survivors had significantly higher incidence of preoperative diabetes mellitus (p = 0.007), higher NYHA class (p = 0.001), higher incidence of renal failure (p = 0.003) and cirrhosis (p = 0.029). Also, non-survivors had significantly higher baseline alanine aminotransferase (ALT, p = 0.009), aspartate transaminase (AST, p = 0.002), bilirubin (p = 0.001) and white cell count (WCC, p = 0.006). Further factors associated with 30-day mortality were longer operating time (p < 0.001), longer CPB time (p < 0.001), longer aortic cross clamp time (p = 0.001), higher RBC, FFP and platelet transfusion requirement (p < 0.001, p = 0.002 and p = 0.007, respectively).Multivariate logistic regression analysis revealed cirrhosis (OR 9.390, 95% CI 1.171–75.328, p = 0.035) and longer CPB time (OR 1.026, 95% CI 1.004–1.048, p = 0.020) as the only independent predictors of 30-day mortality after surgical treatment of endocarditis.

Conclusions: Our experience in patients with infective endocarditis shows satisfactory early, midterm, and long-term results.