Surgical Management of Valvular Infective Endocarditis: A Single-Center Experience

Abstract

Background: The surgical therapy of infective endocarditis (IE) presents considerable challenges, and despite great advancements in preoperative diagnostic and surgical techniques, it continues to be linked with substantial morbidity and death. The aim of this work was to assess our experience with the surgical care of IE, to examine the influence of various perioperative clinical factors on early and midterm outcomes and to assess the influence of perioperative clinical variables pertinent to postoperative problems, morbidities, and mortalities, as well as to identify perioperative prognostic factors.

Methods: This prospective study was carried out on 87 patients aged ≥ 18 years old, with valvular IE, whether native or artificial, treated surgically. Blood cultures (2–3 sets, 5-day incubation) were the diagnostic gold standard, while serology aided in detecting fastidious organisms, with anti-phase I IgG ≥1:800 confirming Q fever endocarditis.

Results: Sex, preoperative renal impairment, active endocarditis, the nature of the valve (native or prosthetic), size of vegetations, microbiological species, and cross-clamping duration exhibit no significant link with surgical mortality. In multivariate regression, Preoperatively, constant were independent predictors of mortality (P=0.001) while Heart rhythm and conduction disturbances, NYHA class (III and IV), Peri-annular abscess, timing of surgery (Emergency), preoperative inotropes and ongoing infection were not.  In Multivariate regression, postoperatively, duration of hospital stay were independent predictors of mortality (P=0.005) while postoperative duration of mechanical ventilation, postoperative pulmonary complications and constant were not.

Conclusions: Swift diagnosis of individuals with IE at elevated risk of death may provide the chance to alter the disease trajectory and enhance prognosis.