Association of Renal Impairment Severity with Surgical Outcomes in Patients with Infective Endocarditis.

Introduction: This study aimed to assess the association of renal impairment (RI) severity on short and mid-term outcomes in patients undergoing cardiac surgery for infective endocarditis (IE).

Methods: Patients undergoing cardiac surgery for IE between January 2010 and October 2022 were included. They were stratified based on preoperative renal function into four groups: Normal (N: Creatinine clearance (CrCl) >85mL/min), moderate RI (M: CrCl 51-85mL/min), severe RI (S: CrCl ≤50mL/min), and haemodialysis-dependent (H). Each group was compared with group N. Survival analysis was performed using Kaplan-Meier curves.

Results: A total of 487 patients (N: 198; M: 154; S: 96; H: 39) were included. Mean age 55.92 ± 14.60 years, 375 (77%) males. Groups M, S, and H vs N demonstrated more atrial fibrillation [17 (11.0%), 20 (20.8%), 6 (15.4%) vs 8 (4.0%); p<0.05]. Groups S and H vs. N had increased incidence of left ventricular ejection fraction <50% [43 (44.8%), 22 (56.4%) vs 43 (21.7%); p<0.001] and preoperative cardiogenic shock [16 (16.7%), 13 (33.3%) vs 9 (4.5%); p<0.001]. The need for postoperative haemodialysis was 21 (13.6%) in M and 23 (23.0%) in S vs. 13 (6.6%) in N (p<0.05). In-hospital mortality was 13 (8.4%), 21 (21.9%), and 11 (28.2%) vs. 12 (6.1%) (p=0.388, <0.001, <0.001), and mortality at a mean of 69.1months was 49 (31.8%), 46 (46.9%), 30 (76.9%) vs. 49 (24.7%) (p=0.142, <0.001, <0.001) in groups M, S, H vs. N, respectively.

Conclusions: The incidence of renal impairment in patients with IE undergoing surgery remains high. Early and mid-term outcomes of those with severe RI and haemodialysis dependence are significantly worse.