Endocarditis: An Ever Increasing Problem in Cardiac Surgery

Abstract

Background Endocarditis remains one of the most threatening diagnoses in cardiac surgery and is still increasing. Particularly, device-related as well as prosthetic endocarditis appears to be on the rise. Early mortality and periprocedural complications are high jeopardizing the success of surgical efforts. We looked at the development of the numbers and the distribution of endocarditis in an all-comer analysis. Methods From 2003 to 2017, 752 patients with endocarditis were transferred to our cardiosurgical institution (mean age 65 ± 13 years; mean logistic EuroSCORE 28.01%; males 74.33%). A total of 89.49% of them were surgically treated; 30.01% redo cases thereof; and 9.17% had been operated previously for acute endocarditis. Results While the total number of cardiosurgical procedures remained relatively stable throughout the years, 20 patients were admitted in 2003 and 79 in 2017 yielding more than fourfold increase (p < 0.001). Early mortality of all patients was 25.1%. Septic emboli occurred in 23.7% and 43.8% cerebral emboli thereof. A significant increase of aortic, mitral, and tricuspid valves involvement was observed (p < 0.001). An increase of device-related endocarditis was also noted (p < 0.001). Conclusion Endocarditis remains a serious problem with high early mortality and morbidity. The vast increase of electrophysiological device implantations has resulted in an increase of tricuspid valve involvement. Liberalization of endocarditis prophylaxis, that is, more restrictive use of antibiotics in 2007 may have at least partially contributed to an increase of the individual risk to suffer from acute endocarditis. A renaissance of a stricter endocarditis–prophylaxis may thus be considered.

Results of Four-Stented Biological Aortic Valves and How They Compare to PARTNER-3

“…The higher pacemaker implantation rate: our and other studies clearly show that pacemaker carriers are prone to develop an endocarditis with all its dire consequences. 23…”

Surgical treatment of valve endocarditis in high-risk patients and predictors of long-term outcomes

“…Infective endocarditis (IE), particularly on a heart valve prosthesis, represents a surgical challenge mostly for two reasons. First, prosthetic valve endocarditis (PVE) and native valve endocarditis (NVE) are a life-threating diseases 1 , 2 . Second, patients with IE are increasingly of advanced age and at high risk.…”

“…Second, patients with IE are increasingly of advanced age and at high risk. In addition, many patients considered at intermediate-to-high risk or inoperable that have undergone transcatheter aortic valve replacement are also susceptible to infective endocarditis on these prostheses 1 , 2 .…”

“…There are well-known patient subsets that are at higher risk of mortality if undergoing cardiac surgery, due to anatomical features of valve heart disease and coexistent comorbidities 3 , with more than 10% of patients considered to be at too high risk for surgery 1 . Although surgical techniques, prosthetic models and anesthetic management have constantly improved over the last years 3 , the increasing number of patients at higher risk for surgery may affect operative success, particularly in terms of higher mortality.…”

Tricuspid Valve Leaflet Repair and Augmentation for Infective Endocarditis

“…4,[6][7][8][9][10] In addition to IVDU, tricuspid IE may result in patients with pacemaker or defibrillator leads, congenital heart disease, and vascular access for dialysis. 6,[10][11][12][13][14] Multiple analyses have reported an increase in tricuspid-related IE corresponding to the increase in IVDU during the same period. 4,12,15,16 While the incidence of all types of tricuspid valve surgery has more than doubled, 17 some institutional surgical volumes for right-sided IE have increased as much as five-fold during the opioid crisis.…”