Early and late outcomes after surgical treatment of infective endocarditis

BACKGROUND: Despite significant advances in the diagnosis and treatment of infective endocarditis (IE), it remains a serious condition associated with significant morbidity and mortality. Recent studies show relatively stable mortality rates despite advances in diagnostic and therapeutic tools, including medical therapy and surgical techniques. This study aims to retrospectively investigate the short-term and long-term outcomes of patients who were diagnosed with definitive infective endocarditis according to the modified Duke Criteria and underwent surgical treatment. METHODS: Forty adult patients who underwent surgical treatment for IE in our clinic between 2014 and 2022 were retrospectively analyzed. Age, gender, demographic characteristics and accompanying comorbidities of the patients were included in the study. Epidemiological features of the patients, native or prosthetic valve endocarditis, previous valve operation history, preoperative TEE/TTE values, presence of preoperative embolism and cerebrovascular accident, indication for operation, microbiological blood culture and isolated microorganisms were documented. The operation data, type of operation performed, the type of valve inserted, cross-clamp time, cardiopulmonary bypass time were analyzed. Postoperative complications (dialysis need, peripheral embolism, cerebrovascular accident, prolonged hospitalization, in-hospital mortality) data were included in the study. The primary endpoint of our study was to evaluate the in-hospital and late mortality of patients who benefited from surgical treatment for infective endocarditis. Secondary endpoints were to investigate the effects of preoperative comorbidities and pre- or post-operative complications on mortality and prognosis. Statistical analysis was performed using the SPSS 26.0 (SPSS Inc. Chicago, IL) package program. Kaplan-Meier method was used to analyze expected survival. RESULTS: Of the patients included in the study, 29 (72.5%) were male and 11 (27.5%) were female. The mean age of the patients was 52.45±12.9 years, ranged between 24 and 76 years old. In our study, a positive blood culture rate of 55% was found and the most frequently isolated microorganism was S.aureus. In 40 patients operated for the diagnosis of IE, 85% (n=34) native valve involvement and 15% (n=6) prosthetic valve involvement were detected. Mitral and aortic valve involvement was present in 43% of the patients, isolated aortic valve endocarditis involvement was found in 27% with the second frequency, isolated mitral valve involvement was found in (25%) 10 patients, and isolated tricuspid valve involvement was detected in 5% of the patients. In terms of operation indication, the most common cause is severe valvular insufficiency due to infective endocarditis, the second most common is embolism and mobile vegetation. In operative values, the mean duration of cross-clamp was 134.4±51.8, and the mean duration of cardiopulmonary bypass was 164.44±74.49 minutes. The most common embolism site was found to be central embolism, and splenic embolism was the second most frequent embolism. In our study, mortality in the early postoperative period and in-hospital mortality was found to be 32.5%. A significant correlation was found between preoperative dialysis and postoperative dialysis need and in-hospital mortality rates (p=0.003) (p<0.001). In the survival Kalpan-Meier analysis of 26 patients who were discharged from the hospital in our study, the median follow-up period of the patients was 31 months. Expected survival was 88.6 months. The estimated survivals at Month 6, Year 1, and Year 2 were 96.2%, 92.1%, and 87%, respectively. In our study, a significant correlation was found between reduced long-term survival and the presence of re-operation and postoperative stroke. CONCLUSION: Despite diagnostic and therapeutic advances, prognosis of surgically treated IE continues to be poor. The increase in morbidity and hospital mortality underline the importance of rapid diagnosis of this disease. Patients with infective endocarditis need prompt response and prompt diagnosis from a multidisciplinary team with timely diagnostic protocol and treatment at the critical stage. Early clinical suspicion and prompt diagnosis are essential to improve patient outcomes and reduce IE-related morbidity and mortality.