Risk Factors for Mortality in Patients Undergoing Cardiothoracic Surgery for Infective Endocarditis

Abstract

Background. This study aimed to identify risk factors associated with mortality of patients who undergo cardiac surgery for infective endocarditis.Methods. A retrospective review was performed of patients with infective endocarditis who underwent cardiac surgery at a quaternary Australian hospital between 2004 and 2014. Patient data were collected and prospectively analyzed.Results. In all, 465 patients underwent surgery during the study period, with 30 deaths (6.45%). Factors independently associated with in-hospital mortality were increasing age (odds ratio [OR] 1.04; 95% confidence interval [CI], 1.01 to 1.07; P [ .009), active bacterial endocarditis at time of operation (OR 4.91; 95% CI, 1.01 to 23.8; P [ .048), preoperative invasive positive pressure ventilation (OR 3.65; 95% CI, 1.18 to 11.27; P [ .025), increasing cardiopulmonary bypass time (OR 1.01; 95% CI, 1.006 to 1.014; P < .001), and increasing European System for Cardiac Operative Risk Evaluation score (OR 21.73; 95% CI, 2.12 to 223.11; P < .01). Conclusions. The in-hospital mortality of patients with infective endocarditis remains significant, with potential risk factors including increasing age, active bacterial endocarditis, preoperative invasive positive pressure ventilation, increasing cardiopulmonary bypass time, and high European System for Cardiac Operative Risk Evaluation score.

Role of Concomitant Coronary Artery Bypass Grafting in Valve Surgery for Infective Endocarditis

“…In addition, valve surgery in the setting of IE is often more complicated than in non-IE pathologies due to multiple valves being affected by IE and the fragility of infected tissues. Thus, adding CABG to such complex surgeries prolongs the duration of CPB and aortic cross clamp times which are known independent predictors of perioperative mortality in patients undergoing cardiac surgery for non-IE [10], as well as for IE [11,12]. In our study, concomitant CABG was indeed associated with longer CPB and cross-clamp durations, and higher in-hospital mortality in the overall patient population.…”

“…The main cause of death in IE is septic multi-organ failure, which is more likely to occur if clamp and bypass times are long [3,[7][8][9]. Adding CABG to valve surgery prolongs the duration of the cardiopulmonary bypass (CPB) and aortic cross-clamping [10][11][12][13]. In addition, the prognostic impact of adding CABG to valve surgery has even been questioned for non-IE patients [14,15].…”

Differences in mortality in patients undergoing surgery for infective endocarditis according to age and valvular surgery

“…From our data, an in-hospital mortality of 20.3% was identified among patients ≥75 years [ 34 ]. A single-center study from Australia, investigated 465 patients undergoing cardiac surgery for IE and found, among other factors, that increasing age, active bacterial endocarditis, and a high European System for Cardiac Operative Risk Evaluation score were associated with an increased risk of in-hospital mortality [ 35 ]. A previously mentioned Spanish study with data from tertiary centers concluded that age was not an independent predictor of in-hospital mortality [ 36 ].…”

“…Our study showed that patients ≥75 years who underwent surgery, the in-hospital and 90-day mortality was tripled compared with patients < 60 years. Several risk-scores have been developed to predict in-hospital mortality in patients with IE with an indication for surgery and age constitutes an important parameter in these risk scores [17][18][19][20]33] [35]. A previously mentioned Spanish study with data from tertiary centers concluded that age was not an independent predictor of in-hospital mortality [36].…”

Anesthesia Considerations in Infective Endocarditis

“…16 A number of risk factors predict outcome in infective endocarditis, especially when surgical treatment is indicated. Patient-and disease-related factors as well as infective endocarditis-mediated complications increasing the risk of mortality have been described 16,20,[56][57][58][59][60][61][62][63][64][65][66] (table 3). The abundance of such risk factors may lead to poor prognosis, and due to the inability to withstand the surgical hit, this could be a reason to avoid surgery.…”