Risk Factors and Predictors of Mortality after Surgery for Infective Endocarditis

Objectives: The risk factors for mortality after surgical therapy of infective endocarditis (IE) are still controversial and there is a lake of the underlying research to guide the community to reduce the impact of infective endocarditis on the postoperative outcomes. This large study was designed to evaluate perioperative risk factors for mortality in patients with IE.

Methods: The study included retrospectively 413 consecutive patients (30-day survivors 82% versus 30-day nonsurvivors 18%) with surgery due to infective endocarditis between January 2002 and February 2020. Univariate and multivariable analyses were conducted to identify the 30 days mortality. Survival was estimated by Kaplan–Meier estimator.

Result: Preoperative status showed nonsurvivors were significantly older (66.2 ± 12 years cs. 59.9 ± 15.2 years; p = 0.001) with higher EuroSCORE II (26.8 [14.4; 49.8] vs. 10.0 [4.2; 22.1]; p < 0.001) and lower ejection fraction (7.5 vs. 23.9%; p < 0.001). Dialysis (8.3 vs. 23.0%, p < 0.001), previous cardiac surgery (38.1 vs. 56.8%; p = 0.003), and stroke (28.4 vs. 17.7%; p = 0.036) were significantly higher among nonsurvivors preoperatively. The presence of intracardiac abscess was nearly two times highly diagnosed in nonsurvivors (36 [48.6%] vs. 77 [23.1%]; p < 0.001). Endocarditis was mostly common after prosthetic implantations (34%) rather than with native valves. Also, mortality was significantly higher in those subgroups with prosthetic endocarditis (43.2% in nonsurvivors vs. 32.7% in survivors; p = 0.049). Intraoperatively, the length of surgery was significantly higher in nonsurvivors (324 vs. 268 minutes; p = 0.001) as well as transfusion of blood conserves 2 (0–15) versus 4 (0–27); p < 0.001. Postoperatively, the incidence of new-onset of hemodialysis was markedly higher in nonsurvivors (52.5 vs. 8.8%; p < 0.001). Nonsurvivors require longer ventilation time (41 [19; 117] vs. 15 [9; 40]; p < 0.001) and suffered from more incidence of cardiopulmonary resuscitation than survivors (17.7 vs. 3.3%; p ≤ 0.001). The logistic regression analysis confirmed that age (OR: 1.028), preoperative acute or chronic dialysis (OR: 2.754), previous cardiac surgery (OR: 2.162), cardiogenic shock (OR: 3.946), and the presence of cardiac abscess (OR: 2.306) are predictable variables for 30-day mortality.

Conclusion: The current analysis showed that the risk factors of mortality in severe infective endocarditis are multifactorial. Age, the presence of cardiac abscess, preoperative acute or chronic dialysis, and previous cardiac surgery are considered major components in mortality after surgical operation with endocarditis.

Publication History

Article published online:
19 February 2021