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Thorac Cardiovasc Surg 2024; 72(08): 587-594
DOI: 10.1055/a-2199-2344
Original Cardiovascular

New Insights into Mortality-Related Risk Factors in Infective Endocarditis: Results from the Brandenburg State Endocarditis Register

Roya Ostovar
1   Department of Cardiovascular Surgery, Heart center Brandenburg, Faculty of Health Sciences Brandenburg, University Hospital Brandenburg Medical School Theodor Fontane, Bernau bei Berlin, Brandenburg, Germany
,
Filip Schroeter
1   Department of Cardiovascular Surgery, Heart center Brandenburg, Faculty of Health Sciences Brandenburg, University Hospital Brandenburg Medical School Theodor Fontane, Bernau bei Berlin, Brandenburg, Germany
,
Frarzane Seifi Zinab
2   Department of Cardiac Surgery, Sana Hospital, Heart Center Cottbus GmbH, Cottbus, Germany
,
Dirk Fritzsche
2   Department of Cardiac Surgery, Sana Hospital, Heart Center Cottbus GmbH, Cottbus, Germany
,
Hans-Heinrich Minden
3   Department of Cardiology, Oberhavel Kliniken GmbH, Hennigsdorf, Brandenburg, Germany
,
Nirmeen Lasheen
3   Department of Cardiology, Oberhavel Kliniken GmbH, Hennigsdorf, Brandenburg, Germany
,
Martin Hartrumpf
1   Department of Cardiovascular Surgery, Heart center Brandenburg, Faculty of Health Sciences Brandenburg, University Hospital Brandenburg Medical School Theodor Fontane, Bernau bei Berlin, Brandenburg, Germany
,
Oliver Ritter
4   Department of Cardiology, Faculty of Health Sciences Brandenburg, University Hospital, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
,
Gesine Dörr
5   Department of Cardiology, Alexianer St. Josef Hospital Potsdam, Potsdam, Germany
,
Johannes Maximilian Albes
1   Department of Cardiovascular Surgery, Heart center Brandenburg, Faculty of Health Sciences Brandenburg, University Hospital Brandenburg Medical School Theodor Fontane, Bernau bei Berlin, Brandenburg, Germany
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Abstract

Objective Endocarditis as a potentially life-threatening disease with high complication and mortality rates. In recent years, an increase in the incident of endocarditis has been reported throughout Europe. In the aging society, successful treatment is complex and challenging owing to the high rate of multimorbidity.

Methods We initiated a statewide prospective multicenter endocarditis registry in 2020. Perioperative risk factors, comorbidities, microbiological, laboratory and imaging diagnostics, complications, and mortality including 1-year follow-up were collected. The present midterm analysis includes factors influencing mortality in the first 313 patients.

Result In-hospital mortality and 1-year mortality were 28.4 and 40.9%, respectively. Preoperative risk factors include age (p < 0.001), EuroSCORE II (p < 0.001), coronary artery disease (p = 0.022), pacemaker probe infection (p = 0.033), preoperative left ventricular ejection fraction (LVEF), systemic inflammatory response syndrome (SIRS), pulmonary edema, heart failure, septic emboli, acute renal failure, impaired coagulation, hypalbuminemia (p < 0.001), and N-terminal prohormone of brain natriuretic peptide (NTproBNP) (p = 0.001). The presence of peri-annular abscess, perforation, and shunt were associated with increased mortality (p = 0.004, 0.001, and 0.004, respectively). In addition, cardiopulmonary bypass time influenced mortality (p = 0.002). The main postoperative causes of death were multi-organ failure, renal failure, vasoplegia, and low-output syndrome (p < 0.001). Previous endocarditis was 7.7%, while 35.5% were prosthetic valve recipients and 33.6% were redo surgeries.

Conclusion Our first registry data show the complexity of endocarditis patients and the challenging treatment. Some risk factors can be treated preoperatively. For instance, hypalbuminemia and the duration of the procedure can be controlled with adequate albumin substitution and carefully planned procedures restricted to the essential requirements, that is, hybrid approaches with consecutive interventions.

Keywords

endocarditis - outcomes (includes mortality morbidity) - heart valve surgery - inflammation systemic (including cells mediators) - surgery - complications

Note

Parts of this work were presented at the 35th EACTS Annual Meeting, Barcelona, October 2021 as well as at the 50th, 51th, and 52th Annual Meeting of the German Society of Thoracic and Cardiovascular Surgery in February 2021, 2022, and 2023.


Authors' Contribution

R.O. was responsible for conceptualization, methodology, investigation, writing original draft, and supervision. F.S. was responsible for formal analysis, visualization, and project administration. F.S.Z. was responsible for data curation and validation. D.F. was responsible for investigation and resources. H.H.M. was responsible for investigation and validation. N.L. was responsible for data curation and validation. MH was responsible for software and data curation. O.R. was responsible for validation and project administration. G.D. was responsible for investigation, methodology, and data curation. J.M.A. was responsible for conceptualization, resources, writing—review and editing, and supervision.




Publication History

Received: 19 March 2023

Accepted: 24 October 2023

Accepted Manuscript online:
26 October 2023

Article published online:
09 February 2024

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