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2013 Research Abstract

Predicting Short and Long-term Operative Outcomes in Infective Endocarditis

Investigator: John Squiers

Mentor: J. Michael DiMaio, MD

Objective: Infective endocarditis is a grave diagnosis with an inherently poor prognosis. This study aimed to utilize a multi-decade database of surgically treated IE patients to identify factors associated with adverse outcomes to augment clinical decision-making for this population. We assessed the database for variables associated with both operative and 2-year mortality.

Methods: Between April 1990 and February 2013, 335 patients underwent operations to treat infective endocarditis. Patients were identified as having IE if they met the Duke criteria for definite or possible endocarditis. From medical records, clinical information was retrospectively recorded. Perioperative medical (antibiotic) therapy was retrospectively graded for appropriateness. Contingency analysis was performed to identify factors associated with or protective against both operative and 2-year mortality.

Results: Mean age for all patients was 47 years. There were 37 (11%) operative mortalities, and 97 (29%) patients had died within 2-years of initial operation. Factors associated with operative morality included patients on hemodialysis (P < 0.001), patients suffering congestive heart failue (P = 0.03), Staphlococcus aureus infection (P < 0.001), prosthetic valve infection (P = 0.005), and incidence of post-operative complication (P < 0.001). Factors associated with 2-year morality included patients on hemodialysis (P < 0.001), patients suffering CHF (P = 0.001), chronic viral hepatitis (P = 0.002), or diabetes (P = 0.04), S. aureus (P < 0.001) and fungal infections (P = 0.003), and incidence of any post-operative complications (P < 0.001). Inappropriate perioperative medical therapy and anatomical location of lesions were not associated with operative or 2-year mortality for culture-positive IE patients.

Conclusions: Several factors are associated with increased operative and 2-year mortality in patients receiving surgical therapy for infective endocarditis. Appropriate perioperative medical therapy is not associated with decreases in mortality. This study can improve clinical decision- making for patients with infective endocarditis under consideration for surgery.

Last updated: 10/2/2014

Updated on September 2, 2014.