Background: Infective endocarditis (IE) is still a serious disease, with a high mortality despite cardiac surgery and modern conservative therapy. However, data on long-term follow-up are sparse.
Methods: Retrospective single centre registry on the hospital course and long-term follow-up of patients with IE undergone a cardiac surgery, conservative therapy with and without an indication for cardiac surgery.
Results: Between 1/2013 and 12/2016, 171 IE patients were treated at our hospital. A follow-up with either patient contact, review of hospital charts or physician contact was performed in 2022. Due to lost to follow-up (n=4) and declined to participate after discharge (n=1), the final evaluation was performed with 166 patients (97.1%). They were followed-up for a median 2385,0 (between 2156,0 and 2773,0) days. 139 (81,3%) of the patients were operated (surgery) and 32 (18,7%) were treated conservatively. Amongst the conservatively treated group, 6,4% (11/32) of the patients had an indication for surgery, but it was decided not to perform it (cons-with) and 12,3% (21/32) had no indication for surgery (cons-without).
Operated patients were younger compared to cons treated patients (65,1 ± 13,0 vs 72,8 ± 15,7, p = 0,00016). Whereas hospital mortality was not different between both groups (21,6 % vs 21,9 %, p = 0,97112), calculated 5y mortality was higher in der cons treated group (71,0 % vs 49,6 %, p=0,03168).
|
|
surgery
n=139
|
cons-with
n=11
|
cons-without
n=21
|
|
Age (years, quartiles)
|
67,0 (58,0; 75,0)
|
78,0 (67,0; 83,0)
|
78,0 (71,0; 83,0)
|
|
Women
|
24,5 %
|
36,4 %
|
23,8 %
|
|
Previous Valve Replacement/Interventions
|
|
|
|
|
Aortic valve
|
77,7 %
|
81,8 %
|
71,4 %
|
|
Mitral valve
|
5,8 %
|
90,9 %
|
95,2 %
|
|
Tricuspid valve
|
99,3 %
|
100,0 %
|
100,0 %
|
|
TAVI
|
2,2 %
|
27,3 %
|
33,3 %
|
|
Positive blood cultures
|
79,9 %
|
81,8 %
|
81,0 %
|
|
Gram positive strains
|
0,9 %
|
11,1 %
|
0,0 %
|
|
native valve IE (NVE)
|
53,2 %
|
36,4 %
|
33,3 %
|
|
prosthetic valve IE (PVE)
|
25,9 %
|
54,5 %
|
52,4 %
|
|
intra-cardiac device related IE or IE associated with central access lines(DRE)
|
20,9 %
|
9,1 %
|
14,3 %
|
|
Mortality
|
61,5 %
|
100,0 %
|
65,0 %
|
|
Calculated 1 year mortality
|
25,2 %
|
72,7 %
|
20,0 %
|
|
Calculated 3 year mortality
|
40,7 %
|
90,9 %
|
35,0 %
|
|
Calculated 5 year mortality
|
49,6 %
|
100,0 %
|
55,0 %
|
|
Endocarditis related mortality
|
|
|
|
|
Probable/certain
|
73,5 %
|
72,7 %
|
30,8 %
|
|
Uncertain
|
15,7 %
|
18,2 %
|
38,5 %
|
|
Not related
|
10,8 %
|
9,1 %
|
30,8 %
|
|
Re-hospitalisation for endocarditis
|
81,3 %
|
60,0 %
|
58,3 %
|
Conclusions
These data on long-term follow-up after IE show a high total mortality amongst all patients regardless of type of therapy, but higher mortality rate after 5 years amongst conservative treated patients (71%) and 49,6% for surgical treated (p= 0,03168). The highest mortality rate after 5 years (100%) was detected in the cons-with compared to 55% in the cons-without group. More than 2/3 of deaths were due to IE. Furthermore, rehospitalisation rate for recurrent IE was also high.
