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Mortality Predictors in Infective Endocarditis Patients Submitted to Surgery – What can be improved?
Session:
Posters (Sessão 1 - Écran 5) - Doença Vascular e Cirurgia Cardíaca
Speaker:
Maria Rita Giestas Lima
Congress:
CPC 2022
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
26. Cardiovascular Surgery
Subtheme:
26.2 Cardiovascular Surgery – Valves
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Maria Rita Giestas Lima; Gonçalo Cunha; Sara Ranchordas; Ana Rita Bello; Rita Amador; Jorge Ferreira; Marisa Trabulo; José Pedro Neves; Miguel Mendes
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u>Background:</u> Infective endocarditis (IE) is associated with a high morbidity and mortality, frequently requiring surgical treatment in high-risk situations. However, even with surgery, mortality remains high. This study aims to evaluate the mortality predictors of IE patients submitted to surgery. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u>Methods:</u> This single-centre retrospective study enrolled patients diagnosed with active IE that underwent surgery from June 2013 to October 2018. The primary outcome was all-cause mortality at 1-year.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u>Results:</u> One-hundred consecutive patients were included, 73% were male, with a median age of 60 years (table 1). Seventy-six had native valve endocarditis (45 aortic, 46 mitral, 5 tricuspid and one pulmonary, with 21 patients having multivalvular IE), 20 prosthetic valve IE (13 aortic, 7 mitral, 12 early IE) and 4 cardiac device related IE (3 related to pacemaker and 1 related to CRT). The most frequent microorganism isolated from blood cultures was <em>Staphylococcus aureus</em> (36.5%) followed by <em>Streptococcus</em> spp. (29.7%). The median EuroSCORE II was 9.37% (IQR 2.41-11.38%). The most common indication for surgery was severe valvular regurgitation (N=54, with 5 prosthesis dehiscence), large vegetations and embolic events (N=49), paravalvular complications (N=40) and shock (N=26).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">During a median follow up of 58 (44-71) months, 30 patients died (1 intra-operatory death) and 7 had recurrence of IE. Predictors of death were male sex (HR 2.342; 95%IC 1.117-4.911; p=0.024), older age (HR 1.053; 95%IC 1.02-1.08; p=0.002), arterial hypertension (HR 5.844; 95%IC 2.483-13.756; p<0.001), atrial fibrillation (HR 2.63; 95%IC 1.255-5.510; p=0.01), diabetes mellitus (HR 2.812; 95%IC 1.324-5.974; p=0.007), acute kidney injury requiring haemodialysis (HR 4.736; 95%IC 1.784-12.571; p=0.002), heart failure in NYHA III-IV (HR 3.959; 95%IC 1.61-9.73; p=0.003) and EuroSCORE II (HR 1.057; 95%IC 1.03-1.08; p<0.001). Prosthetic valve IE was also associated with a higher mortality (HR 2.622; 95%IC 1.190-5.773; p=0.017), as was intracranial haemorrhage (HR 15.374; 95%IC 1.851-127.711; p=0.011) and embolic events (HR 18.330; 95%IC 2.131-157.664).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u>Conclusion:</u> In our study, the potentially modifiable predictors of mortality were the presence of embolic events, kidney dysfunction and a higher functional class of heart failure at time of the surgery, which reflects the need for a timely diagnosis, early administration of adequate antibiotic therapy and a rapid referral for surgery.</span></span></p>
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