Premium
Surgical treatment of infective endocarditis: Results in 831 patients from a single center
Author(s) -
Kilic Arman,
Huckaby Lauren V.,
Hong Yeahwa,
Sultan Ibrahim,
ArandaMichel Edgar,
Thoma Floyd,
Wang Yisi,
Navid Forozan,
Gleason Thomas G.
Publication year - 2020
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.14893
Subject(s) - medicine , infective endocarditis , single center , endocarditis , center (category theory) , surgery , crystallography , chemistry
This study evaluated surgical outcomes of infective endocarditis (IE), with particular attention to the impact of intravenous drug use (IVDU). Methods Adult patients undergoing surgery for IE between 2011 and 2018 at a single center were included and stratified by IVDU. The primary outcome was overall survival. Secondary outcomes included postoperative complications and hospital readmissions. Kaplan‐Meier and multivariable Cox regression were utilized for unadjusted and risk‐adjusted survival analyses, respectively. Cumulative incidence function curves were compared for hospital readmissions. Results A total of 831 patients (mean age 55 years, 34.4% female) were operated on for IE, including 318 (38.3%) with IVDU. Cultures were most commonly positive for streptococcus (25.2%), methicillin‐sensitive Staphylococcus aureus (17.7%), enterococcus (14.3%), or methicillin‐resistant Staphylococcus aureus (8.4%). The most common procedures included isolated aortic valve repair/replacement (18.8%), aortic root replacement (15.9%), mitral valve repair/replacement (26.7%), aortic and mitral valve replacement (8.4%), and tricuspid valve repair/replacement (7.6%). Mean follow‐up was 3.4 ± 2.4 years. Overall 5‐year survival was 64% and was similar between IVDU and non‐IVDU. Multivariable analysis demonstrated that IVDU was not associated with mortality risk. IVDU patients displayed higher rates of all‐cause readmission (61.6% vs 53.9%; P = .03), drug‐use readmission (15.4% vs 1.4%; P < .001), and recurrent endocarditis readmission (33.0% vs 13.0%; P < .001). Conclusions The majority of patients undergoing surgical treatment of IE are alive at 5‐years although readmission rates are high. IVDU is not a risk factor for longitudinal mortality although patients with IVDU are at higher overall readmission risk, driven largely by greater readmissions for drug‐use and recurrent endocarditis.