Surgery for Infective Endocarditis: Outcomes and Predictors of Mortality in 360 Consecutive Patients
Mina Farag, Tobias Borst, Anton Sabashnikov, Mohamed Zeriouh, Bastian Schmack, Rawa Arif, Carsten J. Beller, Aron-Frederik Popov, Klaus Kallenbach, Arjang Ruhparwar, Pascal M. Dohmen, Gábor Szabó, Matthias Karck, Alexander Weymann
Department of Cardiac Surgery, Heart and Marfan Center – University of Heidelberg, Heidelberg, Germany
Med Sci Monit 2017; 23:3617-3626
Available online: 2017-07-25
A retrospective analysis was conducted of the early and long-term outcomes after surgery for infective endocarditis (IE).
MATERIAL AND METHODS: We included 360 patients with IE operated upon between 1993 and 2012. The primary endpoint was overall cumulative postoperative survival at 30 days. Secondary endpoints were early postoperative outcomes and complication rates. Factors associated with 30-day mortality were analyzed.
RESULTS: Mean age was 58.7±14.7 years and 26.9% (n=97) were female. The mean follow-up was 4.41±4.53 years. Postoperative survival was 81.7% at 30 days, 69.4% at 1 year, 63.3% at 5 years, and 63.3% at 10 years. Non-survivors were significantly older (p=0.014), with higher NYHA Class (p=0.002), had higher rates of preoperative diabetes mellitus (p=0.005), renal failure (p=0.001), and hepatic disease (p=0.002). Furthermore, non-survivors had higher baseline alanine aminotransferase (ALT, p=0.048), aspartate transaminase (AST, p=0.027), bilirubin (p=0.013), white cell count (WCC, p=0.034), and CRP (p=0.049). Factors associated with 30-day mortality were longer duration of surgery, CPB, and aortic cross-clamping times (p<0.001, p<0.001, and p=0.003, respectively), as well as higher RBC, FFP, and platelet transfusion requirements (p<0.001, p=0.005, and p<0.001, respectively). Multivariate logistic regression analysis revealed liver cirrhosis (OR 4.583, 95-CI: 1.096–19.170, p=0.037) and longer CPB time (OR 1.025, 95-CI 1.008–1.042, p=0.004) as independent predictors of 30-day mortality.
CONCLUSIONS: Surgical treatment of IE shows satisfactory early, midterm, and long-term results. Multivariate logistic regression analysis revealed cirrhosis and longer CPB time as independent predictors of 30-day mortality.
Keywords: Cardiac Surgical Procedures, Endocarditis, Heart Valve Diseases