Perioperative Complications in Infective Endocarditis

Abstract

Infective endocarditis is a challenging condition to manage, requiring collaboration among various medical professionals. Interdisciplinary teamwork within endocarditis teams is essential. About half of the patients diagnosed with the disease will ultimately have to undergo cardiac surgery. As a result, it is vital for all healthcare providers involved in the perioperative period to have a comprehensive understanding of the unique features of infective endocarditis, including clinical presentation, echocardiographic signs, coagulopathy, bleeding control, and treatment of possible organ dysfunction. This narrative review provides a summary of the current knowledge on the incidence of complications and their management in the perioperative period in patients with infective endocarditis.

Beyond the Valve: Incidence, Outcomes, and Modifiable Factors of Acute Kidney Injury in Patients with Endocarditis Undergoing Valve Surgery — A Retrospective, Single-Center Study

“…The frequency of postoperative AKI in patients with endocarditis can vary depending on various factors, including the severity of the infection, the extent of cardiac involvement, and individual patient characteristics. While precise figures may vary across studies, research suggests that the incidence of AKI in patients undergoing valve surgery for endocarditis can range from 20% to 40% [13,24,25], with some studies reporting higher rates in more severe cases [9]. The incidence of postoperative AKI in our study population was substantial, with 35.4% of patients experiencing this complication.…”

“…In the context of endocarditis, the risk of postoperative AKI may be heightened due to the infectious nature of the condition, potentially exacerbating the inflammatory response and contributing to renal complications [24]. The frequency of postoperative AKI in patients with endocarditis can vary depending on various factors, including the severity of the infection, the extent of cardiac involvement, and individual patient characteristics.…”

Multidisciplinary Perspectives of Challenges in Infective Endocarditis Complicated by Septic Embolic-Induced Acute Myocardial Infarction

“…Valvular dysfunction in IE is worse when IE is complicated by AMI through septic embolization, via two mechanisms which cause valve regurgitation volume overload due to IE, but also valve regurgitation due to AMI. In septic embolization from IE, the incidence of heart failure is increased to 70%, and mortality is doubled [ 58 ]. One of the most frequent causes of HF include leaflet perforation and rupture, along with mitral chordal rupture, resulting in the development of severe valvular regurgitation or the exacerbation of pre-existing valvular regurgitation [ 12 , 13 ].…”

“…The diagnosis of HF complicated by septic embolic-induced AMI is primarily based on clinical presentation and ECG, confirmed with an echocardiography. Other diagnostic tools, such as coronary angiography and cardiac biomarkers (troponin and B-type natriuretic peptide), may also be used in the perioperative period to assess circulatory dysfunction and the extent of myocardial damage [ 13 , 58 ].…”

“…Treatment includes temporary pacing or the implantation of a permanent pacemaker, as well as a temporary pharmacological treatment. Emergency surgical indication is maintained in the case of severe conduction disorders such as atrioventricular block, as this presents an increased risk of adverse outcomes [12,13,58 Septic shock represents a particularly deadly complication of IE, affecting around 5-10% of patients. The risk factors for septic shock include infections caused by Gram-negative bacteria and S. aureus, persistent bacteremia, acute renal failure, the acquisition of infection in healthcare settings, the presence of large vegetations, emboli in the central nervous system, and diabetes mellitus [13].…”