1Klinikum der Stadt Ludwigshafen gGmbH Medizinische Klinik B Ludwigshafen am Rhein, Deutschland; 2IHF GmbH Ludwigshafen am Rhein, Deutschland; 3Klinikum der Stadt Ludwigshafen gGmbH Ludwigshafen am Rhein, Deutschland
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.