Infective Endocarditis: Do Registry Data Help Improve Treatment Strategies?

Background: Endocarditis as a potentially life-threatening disease and characterized by severe courses, high complication and mortality rates. In recent years, increasing cases of infective endocarditis have been reported throughout Europe. In the aging society, successful treatment is complex and challenging owing to the high rate of multimorbidity. National registry data are still missing.

Method: We initiated a statewide prospective multicenter endocarditis registry in 2020 after registration in WHO, approved by the Ministry of Health and Ethics’ vote. Perioperative risk factors, comorbidities, microbiological, laboratory and imaging diagnostics, perioperative complications, and mortality including 1-year follow-up were collected. The present midterm analysis includes factors influencing mortality in the first 300 patients.

Results: Patients were predominantly male (75.8%), with a mean age of 67.5 years and EuroSCORE II of 14.8%. In-hospital mortality and 1-year mortality rates were 30.5 and 38.7%, respectively. Several factors could be identified showing significant influence on in-hospital mortality. These included preoperative risk factors such as age (p = 0.015), EuroSCORE II (p < 0.001), previous pneumonia (p = 0.035), coronary artery disease (p = 0.015), pacemaker probe infection (p = 0.007), preoperative LVEF (p = 0.005), SIRS (p < 0.001), pulmonary edema (p = 0.001), heart failure (p = 0. 002), septic emboli (p = 0.003), acute renal failure (p < 0.001), impaired coagulation (p = 0.001), NTproBNP (p = 0.001), and hypalbuminemia (p = 0.002). Presence of periannular abscess, perforation, and shunt was also associated with increased mortality (p = 0.048, p = 0.31, p = 0.035). In addition, cardiopulmonary bypass time influenced mortality (p = 0.004). The most frequent postoperative causes of death were multiple organ failure, renal failure, vasoplegia (p < 0.001), and low-output syndrome (p = 0.016). 43.9% of patients belonged to the high-risk group, 12.6% had previous endocarditis, 41.6% were previous prosthetic valve recipients, and 35.3% had redo surgery.

Conclusion: Our first registry data show the complexity of endocarditis patients and the challenging treatment. Majority of results support risk factors reported by other studies. Part of the risk factors can be treated preoperatively. We could show, for instance, the influence of hypalbuminemia and the duration of the procedure. These can be controlled with adequate substitution and carefully planned procedures restricted to the essential requirements, that is, hybrid approaches with consecutive interventions.

Publication History

Article published online:
28 January 2023