Long term outcome and EuroSCORE II validation in native valve surgery for active infective endocarditis in a South African cohort

Abstract

There has been little change in the mortality from infective endocarditis, despite the diagnostic and therapeutic advances made in the last 25 years. The current in-hospital mortality rate for patients with IE is 15% -20%, with 1-year mortality approaching 40%. The morbidity associated with infective endocarditis includes: valvular incompetence, embolisation, cerebrovascular accidents and congestive heart failure which have influenced the surgical approaches to a great extent. Infective endocarditis is a significant problem in sub-Saharan Africa and is related to a high prevalence of rheumatic heart disease among the young indigent population. Africa has the highest burden of rheumatic heart disease contributing 17% -43% of all heart disease.

Infective endocarditis in South Africa

“…Approximately half of patients presenting with IE in the developed world, require surgery (22,24). This is similar to the rates reported for patients in South Africa (5,6), although our current experience is that the majority of patients will require surgery.…”

“…A prospective observational trial of patients with IE conducted at Tygerberg Hospital, Cape Town, South Africa reported a mean age of 37.7 years-72% of patients had underlying RHD (5). A more recent study conducted in Cape Town, South Africa revealed similar results with up to 80% of patients with NVE having evidence of underlying RHD (6). The Echoin-Africa (EIA) study screened over 6,000 secondary school pupils in the Tygerberg Hospital referral network (Cape Town, South Africa) and found a prevalence of 20/1,000 of pupils screened to have borderline or definite RHD, as per the World Health Federation criteria (7) for the detection of RHD (unpublished data).…”

“…Staphylococci, usually associated with health-care contact and invasive procedures has overtaken Streptococci as the most common causative organism in developed nations (1,4,9). The significant incidence of culture negative endocarditis observed in South African cohorts raises questions regarding the true microbiology of IE in South Africa (5,6). It must be noted that these reports predate modern algorithms of microbe detection as well as modern imaging that enable earlier detection and more accurate diagnosis.…”

“…The majority of these patients were treated with antibiotics prior to blood cultures taken and this was proposed to be the major contributor to the very high incidence of BCNIE (5). Recent reports from South Africa have revealed BCNIE in 30% of patients (6,10). The etiology of BCNIE varies according to region, reflecting differences in local pathogens, initiation of antibiotics prior to taking blood cultures, inadequate blood culture sampling and incorrect interpretation of imaging findings.…”

Cirurgia cardíaca e o risco de mortalidade a partir do EUROSCORE II

“…Dessa forma, ainda que a taxa de mortalidade observada tenha sido estatisticamente significativa, nossos resultados foram menores que no estudo do EuroSCORE II (Nashef et al, 2012) que a mortalidade em 30 dias e 90 dias foi 4,04% e 6,02%, respectivamente. Os resultados deste estudo foram mais baixos também quando comparados com resultados de um estudo realizado no sul africano, onde a mortalidade aos 30 dias e 90 dias foi 11% e 15%, respectivamente (Koshy et al, 2018).…”