Surgery in drug use-associated infective endocarditis: long-term survival is negatively affected by recurrence

Abstract

OBJECTIVES The prevalence of infectious endocarditis (IE) in intravenous drug users (IDUs) is increasing, and the number of patients who need surgery is also rising. Relatively little is known about the short-term and long-term outcomes of these operations. METHODS This study is a retrospective analysis of our institutional results, focussing on risk factors for perioperative death, major adverse events and long-term survival. A total of 50 of the 66 (75.75%) patients had postoperative follow-up, and the mean follow-up time was 53.9 ± 9.66 months. Patients were divided into 2 groups depending on whether they were having their first operation or were being reoperated for recurrent IE. RESULTS From March 2006 to December 2015, a total of 158 patients underwent surgery for IE; 72 (45.6%) of them were identified as active IDUs. The operative mortality in IDUs was 8.33% (6 patients), with no significant difference between the 2 groups (P = 0.6569). Survival rates at 1 year, at 3 years and at the end of follow-up were 92%, 72% and 64%, respectively. There was significantly worse survival of patients with recurrent IE (log-rank test, P = 0.03). CONCLUSIONS Although the short-term results of operation for IE in IDUs are good, long-term outcomes are not satisfactory. The survival of patients with recurrence of IE caused by return to intravenous drug use is significantly worse.

Infective endocarditis in intravenous drug abusers: clinical challenges emerging from a single-centre experience

“…In contrast with the experience of Rohn et al [ 3 ], we did not find higher mortality even after multiple relapses. Moreover, since we could not identify any predictor of a futile surgery, this reinforces the concept that any patient with a complicated IE deserves surgery without delay, irrespective of its aetiology.…”

“…On the other hand, the long-term outcome of IDA patients is very unsatisfactory, as shown by Rohn et al [ 3 ] but, at least in large part, likely attributable to continuing drug abuse, as suggested by a 2.3 increase in the risk of death at multivariate analysis in our series.…”

“…Other series reported that the risk of death or reoperation was ten times higher in IDA-associated than non-associated IE [ 4 ]. Rohn et al [ 3 ], over a follow-up exceeding four years, found that survival was significantly impaired in patients with recurrent IE. Weymann et al [ 13 ] identified pre-operative NYHA class grade IV as a risk factor for early mortality.…”

Clinical outcomes of percutaneous debulking of tricuspid valve endocarditis in intravenous drug users

“…[13][14][15] The evidence base, however, is built largely on reports of clinical experience and expert consensus. In fact, reviews of patients undergoing surgical debridement show an association with significant morbidity and mortality, [16][17][18][19][20] with mortality being driven often by persistent sepsis. 21 A recent retrospective cohort assessing the surgical verses medical management of isolated TVE in IVDU by Shetty et al actually suggested no mortality benefit at 2 years.…”

“…The evidence base, however, is built largely on reports of clinical experience and expert consensus. In fact, reviews of patients undergoing surgical debridement show an association with significant morbidity and mortality, 16‐20 with mortality being driven often by persistent sepsis 21 …”