SPC365

Addressing Complications in Infective Endocarditis: The Critical Role of Surgical Intervention Post-2023 Guidelines

Session: SESSÃO DE POSTERS 54 - INTERVENÇÃO MITRAL PERCUTÂNEA E CIRURGIA CARDÍACA
Speaker: Mariana Duarte Almeida

Congress: CPC 2025
Topic: H. Interventional Cardiology and Cardiovascular Surgery
Theme: 26. Cardiovascular Surgery
Subtheme: 26.11 Cardiovascular Surgery - Other
Session Type: Cartazes
FP Number: ---
Authors: Mariana Duarte Almeida; João Gouveia Fiuza; Gonçalo Marques Ferreira; Oliver Correia Kungel; Francisco Rodrigues Santos; Vanda Devesa Neto; Nuno Craveiro

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong><span style="font-family:&quot;Aptos Narrow&quot;,sans-serif">Introduction:</span></strong><span style="font-family:&quot;Aptos Narrow&quot;,sans-serif">&nbsp;Infective endocarditis (IE) is a severe disease with reported mortality rates ranging from 8% to 40%. Treatment is based on targeted antibiotic therapy and source control, which sometimes requires surgical intervention. The primary indications for surgery include heart failure, uncontrolled infection, and embolization. Performing early surgery is&nbsp;critical to reducing the mortality associated with IE. In fact, recent guidelines recommend urgent surgery (within 3&ndash;5 days) when the risk of embolization is high, particularly in cases of large vegetations.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong><span style="font-family:&quot;Aptos Narrow&quot;,sans-serif">Purpose:</span></strong><span style="font-family:&quot;Aptos Narrow&quot;,sans-serif">&nbsp;This study aimed to evaluate the mortality associated with IE, particularly by identifying IE-related complications and assessing the role of surgical treatment in a center without cardiac surgery.&nbsp;</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong><span style="font-family:&quot;Aptos Narrow&quot;,sans-serif">Methods:</span></strong><span style="font-family:&quot;Aptos Narrow&quot;,sans-serif">&nbsp;Retrospective data were collected over 5 years (December 2018 to December 2023) from hospitalizations due to IE. Demographic data, clinical data, and outcomes were recorded. Mortality at a 6-month&nbsp;follow-up was analyzed. </span>Group-wise comparisons were performed using Chi-square and Independent t-tests. </span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong><span style="font-family:&quot;Aptos Narrow&quot;,sans-serif">Results:</span></strong><span style="font-family:&quot;Aptos Narrow&quot;,sans-serif">&nbsp;A total of 88 pts were included, of whom 33.0%&nbsp;were female, with a mean age of 69.6 &plusmn; 12.2 years. Native valve IE was diagnosed in 57.5% of pts, prosthetic valve IE in 34.5%, and device-associated IE in 8.0%. The aortic valve was the most affected site (62.5%), followed by the mitral valve (31.3%). The most frequent etiological agents were&nbsp;<em>Staphylococci</em>&nbsp;(37.5%),&nbsp;<em>Streptococci</em>&nbsp;(22.7%), and&nbsp;<em>Enterococci</em>&nbsp;(15.9%). An indication for surgery was identified in 63 pts (87%), with the following complications reported: heart failure (n=30), including cardiogenic shock (n=12); local complications (n=38), with perivalvular abscess being the most common (n=13); vegetations &ge;10 mm (n=19); and cerebral embolization (n=17). The average hospital stay in our center&nbsp;was 50.2 &plusmn; 25.8 days (4&ndash;125). Of the included pts, 21 died in our center, and&nbsp;28 pts were transferred and had surgical intervention. The mean time from&nbsp;diagnosis to surgery was 43.3 &plusmn; 27.2 days (2-117). There was higher 6-month mortality among pts with a surgical indication who did not undergo surgery during the hospitalization (n=17) compared to those who did (n=2), p&lt;0.001. Among pts who underwent surgery, no correlation could be established between the time from diagnosis to surgery and mortality.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong><span style="font-family:&quot;Aptos Narrow&quot;,sans-serif">Conclusions:</span></strong><span style="font-family:&quot;Aptos Narrow&quot;,sans-serif">&nbsp;Early identification of IE-related complications and&nbsp;surgical resolution is&nbsp;essential for better patient outcomes. This study shows a significant mortality difference between pts with surgical indication that underwent surgery comparing with those who did not. Although the guidelines recommend early surgical intervention, this was not consistently observed in our hospital. Further studies are needed to understand the causes of this delay. This study represents an opportunity to review current practices and optimize patient management workflows.</span></span></span></span></p>