Risk factors associated with surgical treatment of infective endocarditis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 CHEN Zonghui ,  LI Feng , ZHAO Jinlong , FU Liang , NI Yinkai , LU Zhexin

Deparment of Cardiovascular Surgery of Shanghai Jiaotong University Affiliated Sixth People’s Hospital, Shanghai, 200233, P.R. China;

Corresponding author：

LI Feng, Email: cardiosh@aliyun.com

Keywords：

Infective endocarditis; risk factors; time of operation

DOI：

10.7507/1007-4848.201809042

Video：

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Objective To analyze the risk factors of the death associated with infective endocarditis, and to evaluate the timing of surgical treatment of infective endocarditis. Methods We retrospectively analyzed the clinical data of 62 patients with infective endocarditis in our hospital between August 2015 and August 2017. There were 43 males and 19 females at age of 19–75 (46.1±16.6) years. The clinical data were divided into a death group and a survival group, a paravalvular leakage group and a no periannular leakage group, an emergency operation group and a non-emergency operation group.The risk factors of infective endocarditis and the choice of operation time were analyzed. Results Three of the 62 patients (4.8%) died after surgery. Postoperative perivalvular leakage (regurgitation over 2 mm) in 8 patients, accounting for 12.9% of the total. Univariate analysis showed that albumin content, creatinine level, total cardiopulmonary bypass time and ascending aorta occlusion time were significantly associated with early postoperative mortality (P<0.05). The results of logistic analysis showed that age, preoperative albumin level, creatinine level, total cardiopulmonary bypass time, and ascending aorta occlusion time were significantly associated with early postoperative perivascular leakage (P<0.05), and long ascending aorta occlusion time is an independent risk factor for early death (P<0.05). There was no statistical difference in early death and the perivalve leakage between the emergency operation and the non emergency operation. Conclusion Patients with infective endocarditis should accept early surgical treatment. The choice of surgical approach should be selected according to the actual situation of patients. And we should pay more attention to albumin and creatinine levels in preoperative patients. In the operation, to shorten extracorporeal circulation time and aortic clamping time can improve the prognosis of patients.

Citation： CHEN Zonghui, LI Feng, ZHAO Jinlong, FU Liang, NI Yinkai, LU Zhexin. Risk factors associated with surgical treatment of infective endocarditis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(6): 558-564. doi: 10.7507/1007-4848.201809042 Copy

1.	Baddour LM, Wilson WR, Bayer AS, et al. Infective endocarditis in adults: diagnosis, antimicrobial therapy, and management of complications: a scientific statement for healthcare professionals from the American Heart Association. Circulation, 2015, 132(15): 1435-1486.
2.	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(19): 2070-2076.
3.	Habib G, Lancellotti P, Antunes MJ, et al. 2015 ESC guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC)Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Assoc. World Clinical Drugs, 2016, 69(1): 69.
4.	Chu VH, Park LP, Athan E, et al. Association between surgical indications, operative risk, and clinical outcome in infective endocarditis clinical perspective. Circulation, 2015, 131(2): 131.
5.	Kang DH. Timing of surgery in infective endocarditis. Heart, 2015, 101(22): 1786-1791.
6.	Delahaye F. Is early surgery beneficial in infective endocarditis? A systematic review. Arch Cardiovasc Dis, 2011, 104(1): 35-44.
7.	Muñoz P, Kestler M, De Alarcon A, et al. Current epidemiology and outcome of infective endocarditis: a multicenter, prospective, cohort study. Medicine (Baltimore), 2015, 94(43): e1816.
8.	Mirabel M, Rattanavong S, Frichitthavong K, et al. Infective endocarditis in the Lao PDR: clinical characteristics and outcomes in a developing country. Int J Cardiol, 2015, 180: 270-273.
9.	Delahaye F, M’Hammedi A, Guerpillon B, et al. Systematic search for present and potential portals of entry for infective endocarditis. J Am Coll Cardiol, 2016, 67(2): 151-158.
10.	Baddour LM, Wilson WR, Bayer AS, et al. Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America. Circulation, 2005, 111(23): e394-e434.
11.	Morita K, Sasabuchi Y, Matsui H, et al. Outcomes after early or late timing of surgery for infective endocarditis with ischaemic stroke: a retrospective cohort study. Interact Cardiovasc Thorac Surg, 2015, 21(5): 604-609.
12.	Said SM, Abdelsattar ZM, Schaff HV, et al. Outcomes of surgery for infective endocarditis: a single-centre experience of 801 patients. Eur J Cardiothorac Surg, 2017: doi: 10.1093/ejcts/ezx341.[Epub ahead of print.
13.	Kang DH, Kim YJ, Kim SH, et al. Early surgery versus conventional treatment for infective endocarditis. N Engl J Med, 2012, 366(26): 2466-2473.
14.	Delahaye F, Chu VH, Altclas J, et al. One-year outcome following biological or mechanical valve replacement for infective endocarditis. Int J Cardiol, 2015, 178: 117-123.
15.	Gatti G, Benussi B, Gripshi F, et al. A risk factor analysis for in-hospital mortality after surgery for infective endocarditis and a proposal of a new predictive scoring system. Infection, 2017, 45(4): 413-423.

1. Baddour LM, Wilson WR, Bayer AS, et al. Infective endocarditis in adults: diagnosis, antimicrobial therapy, and management of complications: a scientific statement for healthcare professionals from the American Heart Association. Circulation, 2015, 132(15): 1435-1486.
2. 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(19): 2070-2076.
3. Habib G, Lancellotti P, Antunes MJ, et al. 2015 ESC guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC)Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Assoc. World Clinical Drugs, 2016, 69(1): 69.
4. Chu VH, Park LP, Athan E, et al. Association between surgical indications, operative risk, and clinical outcome in infective endocarditis clinical perspective. Circulation, 2015, 131(2): 131.
5. Kang DH. Timing of surgery in infective endocarditis. Heart, 2015, 101(22): 1786-1791.
6. Delahaye F. Is early surgery beneficial in infective endocarditis? A systematic review. Arch Cardiovasc Dis, 2011, 104(1): 35-44.
7. Muñoz P, Kestler M, De Alarcon A, et al. Current epidemiology and outcome of infective endocarditis: a multicenter, prospective, cohort study. Medicine (Baltimore), 2015, 94(43): e1816.
8. Mirabel M, Rattanavong S, Frichitthavong K, et al. Infective endocarditis in the Lao PDR: clinical characteristics and outcomes in a developing country. Int J Cardiol, 2015, 180: 270-273.
9. Delahaye F, M’Hammedi A, Guerpillon B, et al. Systematic search for present and potential portals of entry for infective endocarditis. J Am Coll Cardiol, 2016, 67(2): 151-158.
10. Baddour LM, Wilson WR, Bayer AS, et al. Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America. Circulation, 2005, 111(23): e394-e434.
11. Morita K, Sasabuchi Y, Matsui H, et al. Outcomes after early or late timing of surgery for infective endocarditis with ischaemic stroke: a retrospective cohort study. Interact Cardiovasc Thorac Surg, 2015, 21(5): 604-609.
12. Said SM, Abdelsattar ZM, Schaff HV, et al. Outcomes of surgery for infective endocarditis: a single-centre experience of 801 patients. Eur J Cardiothorac Surg, 2017: doi: 10.1093/ejcts/ezx341.[Epub ahead of print.
13. Kang DH, Kim YJ, Kim SH, et al. Early surgery versus conventional treatment for infective endocarditis. N Engl J Med, 2012, 366(26): 2466-2473.
14. Delahaye F, Chu VH, Altclas J, et al. One-year outcome following biological or mechanical valve replacement for infective endocarditis. Int J Cardiol, 2015, 178: 117-123.
15. Gatti G, Benussi B, Gripshi F, et al. A risk factor analysis for in-hospital mortality after surgery for infective endocarditis and a proposal of a new predictive scoring system. Infection, 2017, 45(4): 413-423.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Risk factors associated with surgical treatment of infective endocarditis

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