Surgical Treatment of Left-Sided Infective Endocarditis: 15 Years of Experience

Abstract

Introduction and Objectives: Infective endocarditis (IE) presents a high mortality rate despite medical and surgical advances. The objective of this study is to describe our experience in the surgical treatment of left-sided valvular IE.

Methods: A retrospective analysis was performed on patients operated for left-sided valvular IE from March 2006 to August 2023. Fine-gray competitive risk regression model was used to analyze recurrence, while logistic regression and Cox regression models were assessed to identify independent variables associated with hospital mortality and long-term mortality.

Results: Out of 566 patients diagnosed with IE, 352 (62.2%) underwent surgery for left-sided valvular involvement. Of these patients, 65.9% were male with a median age of 67.8 years. The causative microorganism was isolated in 84.4% of cases. Hospital mortality was 19.0% (n = 67). Age over 69 years and preoperative cardiogenic shock were independent risk factors for hospital mortality. A recurrence of endocarditis was observed in 11.7% (n = 41) of patients (26 relapses and 15 reinfections), with prosthetic endocarditis being an independent risk predictor (HR 2.03 (CI 1.09–3.79); p = 0.004). Survival rates at 1, 5, and 10 years were 75.2%, 66.2%, and 47.1%, respectively. Age over 60 years, preoperative cardiogenic shock, preoperative moderate left ventricular dysfunction, mitral surgery, postoperative low cardiac output, postoperative acute kidney injury AKIN III, and postoperative stroke were independent variables associated with long-term mortality.

Conclusions: Surgery is indicated in more than 60% of patients with IE. Despite this, IE remains a complex disease associated with high in-hospital morbidity and mortality and a decrease in long-term survival.