Experience of surgical treatment of infective endocarditis in children

Abstract

Surgical treatment of infectious endocarditis in children, single-center experience. The paper analyzes the experience of surgical treatment of infectious endocarditis (IE) in children. In the period from January 1999 to July 2019, 69 children with IE were operated at National Amosov Institute of Cardiovascular Surgery of NAMS of Ukraine, 44 of them (63.8%) developed the disease on the background of congenital heart defects (CHD). The mean age of the patients at the time of surgery was 9.1 ± 6.1 years. The average weight is 31.5 ± 21.7 (3.6 to 85 kg). The duration of the disease at the time of hospitalization was 5.3 ± 1.1 months. The average duration of the fever before hospitalization was 10.2 ± 8.5 weeks. Among the causes of IE, we observed three groups of inflammatory diseases: infections of the skin and subcutaneous fat in 15 (21.7%) cases, pathology of ENT – organs – 14 (20.2%) and broncho-pulmonary diseases – 9 (13.1%) cases. The risk factors were: presence of CHD – 44 (63.7%) and also nosocomial factors. The microbiological spectrum of pathogens included gram-positive microorganisms – 33 (71.7%), gram-negative microorganisms 4 (8.7%) and fungal microflora 9 (19.6%). The mean values of bypass circulation were 111.5 ± 62.4 minutes, and the time of aortic clamping was 71.4 ± 43.9 minutes, respectively. Hospital mortality in the general group of patients was 4 (5.8%) cases. In the follow-up period, 59 patients were examined, representing 90.7% of those discharged at the hospital stage. The observation period lasted from one month to 19.4 years (9.6 ± 5.7 years). According to the Kaplan-Meier analysis, the cumulative survival rate of patients in the CHD group at one year after surgery was 97.1%, at 10 years – 93.5%; after 15 years – 93.5%. Survival in the non-CHD group at 5, 10, and 15 years was 100%. In the long term, two patients died (3.4%). The recurrence rate of IE in the distant period was 2 (3.4%) cases. The incidence of long-term reoperation was 8 (13.6%) cases, three were recurrent IE and five were non-recurrent. According to Kaplan-Meier analysis, the proportion of patients without recurrent surgery in the long-term follow-up at 5 years was 87.9%, at 10 years – 84.1%, after 15 years – 77.1% in the CHD group. In the group without CHD 5 years – 95.2%, 10 years – 95.2%, 15 years – 81.6%. In the long term, as a result of performed surgical interventions, the regression of clinical manifestations of heart failure was noted in the majority of patients.