Early Surgical Outcomes in Infective Endocarditis Before and During COVID-19 Pandemic

Abstract

Background Infective endocarditis (IE) is associated with extremely high surgical mortality. During the SARS-CoV-2 pandemic, hospitals restructured their intensive care units and outpatient services to prioritize COVID-19 care, which may have affected the outcomes of patients requiring urgent procedures. This study aimed to evaluate the impact of the pandemic on surgical outcomes of IE patients in Southern Germany.

Methods This observational, community-based study compared two cohorts of surgical candidates: a pandemic cohort from March 2020 to November 2021 (n = 84) and a pre-pandemic cohort from August 2018 to March 2020 (before the lockdown, n = 94). Preoperative status and postoperative in-hospital complications were analyzed and compared between the groups.

Results The pandemic cohort experienced longer symptom onset to diagnosis intervals (14.5 versus 8 days, p = 0.529). A higher incidence of definite IE was observed after the lockdown according to the modified Duke criteria (82.1% versus 68.1%, p = 0.035). Patients presented with more severe symptoms post-lockdown (NYHA Class III: 50% versus 33%; Class IV: 22.6% versus 11.7%, p = 0.001). Postoperative complications, such as re-thoracotomy due to bleeding and hemofiltration for acute renal failure, were significantly more frequent after the lockdown (p < 0.05). However, in-hospital survival rates did not differ significantly between the groups.

Conclusion The COVID-19 pandemic and related lockdown measures were associated with delayed diagnoses and worse perioperative outcomes for surgical IE patients, highlighting the need for improved management strategies during public health crises.

Keywords

COVID-19 - heart surgery - endocarditis

Publikationsverlauf

Eingereicht: 18. August 2024

Angenommen: 25. November 2024

Accepted Manuscript online:
27. November 2024

Artikel online veröffentlicht:
20. Januar 2025

• References

• 1 Baddour LM, Wilson WR, Bayer AS. et al; American Heart Association Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Young, Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and Stroke Council. Infective endocarditis in adults: diagnosis, antimicrobial therapy, and management of complications: a scientific statement for healthcare professionals from the American Heart Association. Circulation 2015; 132 (15) 1435-1486
• 2 Delahaye F, Alla F, Béguinot I. et al; AEPEI Group. In-hospital mortality of infective endocarditis: prognostic factors and evolution over an 8-year period. Scand J Infect Dis 2007; 39 (10) 849-857
• 3 Habib G, Lancellotti P, Antunes MJ. et al. 2015 ESC Guidelines for the management of infective endocarditis: The task force for the management of infective endocarditis of the European Society of Cardiology (ESC). . Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J 2015; 36: 3075-3128
• 4 Chu VH, Cabell CH, Benjamin Jr DK. et al. Early predictors of in-hospital death in infective endocarditis. Circulation 2004; 109 (14) 1745-1749
• 5 McDonald EG, Aggrey G, Tarik Aslan A. et al. Guidelines for diagnosis and management of infective endocarditis in adults: a WikiGuidelines group consensus statement. JAMA Netw Open 2023; 6 (07) e2326366
• 6 Delgado V, Ajmone Marsan N, de Waha S. et al; ESC Scientific Document Group. 2023 ESC Guidelines for the management of endocarditis. Eur Heart J 2023; 44 (39) 3948-4042
• 7 Huang C, Wang Y, Li X. et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395 (10223): 497-506
• 8 WHO. Coronavirus (COVID-19) Dashboard. World Health Organization. 2024 . Accessed April 22, 2024 at: https://covid19.who.int/
• 9 BSG. Bavarian regulation on a temporary exit restriction due to the corona pandemic. Bavarian State Government. 2020 . Accessed June 6, 2021 at: https://www.verkuendung-bayern.de/baymbl/2020-130/
• 10 BSG. Determination of the disaster in Bavaria. Bavarian State Government. 2020 . Accessed June 6, 2021 at: https://www.verkuendung-bayern.de/baymbl/2020-130/
• 11 BSG. Postponement of elective procedures and planned treatments in hospitals. Bavarian State Government. 2020 . Accessed June 6, 2021 at: https://www.verkuendung-bayern.de/baymbl/2020-151/
• 12 Li JS, Sexton DJ, Mick N. et al. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis 2000; 30 (04) 633-638
• 13 Eichinger S, Kikhney J, Moter A, Wießner A, Eichinger WB. Fluorescence in situ hybridization for identification and visualization of microorganisms in infected heart valve tissue as addition to standard diagnostic tests improves diagnosis of endocarditis. Interact Cardiovasc Thorac Surg 2019; 29 (05) 678-684
• 14 Fowler VG, Durack DT, Selton-Suty C. et al. The 2023 Duke-International Society for Cardiovascular Infectious Diseases criteria for infective endocarditis: updating the modified Duke criteria. Clin Infect Dis 2023; 77 (04) 518-526
• 15 Escolà-Vergé L, Cuervo G, de Alarcón A, Sousa D, Barca LV, Fernández-Hidalgo N. IE COVID-19 investigators. Impact of the COVID-19 pandemic on the diagnosis, management and prognosis of infective endocarditis. Clin Microbiol Infect 2021; 27 (04) 660-664
• 16 Liu X, Miao Q, Liu X, Zhang C, Ma G, Liu J. Outcomes of surgical treatment for active infective endocarditis under COVID-19 pandemic. J Card Surg 2022; 37 (05) 1161-1167
• 17 Havers-Borgersen E, Fosbøl EL, Butt JH. et al. Incidence of infective endocarditis during the coronavirus disease 2019 pandemic: a nationwide study. Int J Cardiol Heart Vasc 2020; 31: 100675
• 18 Mikus E, Fiorentino M, Sangiorgi D. et al. Surgical treatment of active endocarditis pre- and post-COVID-19 pandemic onset. Biomedicines 2024; 12 (01) 12