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Thorac Cardiovasc Surg 2023; 71(01): 38-45
DOI: 10.1055/s-0041-1727231
Original Cardiovascular

Outcomes after Surgery for Endocarditis among Intravenous Drug Users and Nonusers

Antti Huuskonen
1   Department of Cardiac Surgery, Heart and Lung Center, Helsinki University Hospital, Helsinki, HUS, Finland
,
Risto Kesävuori
1   Department of Cardiac Surgery, Heart and Lung Center, Helsinki University Hospital, Helsinki, HUS, Finland
,
Peter Raivio
1   Department of Cardiac Surgery, Heart and Lung Center, Helsinki University Hospital, Helsinki, HUS, Finland
› Author Affiliations Funding This work was supported by Finnish state funding for the Helsinki University Hospital regional expert responsibility area.
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Abstract

Background The optimal treatment strategy for intravenous drug users (IVDU) with infective endocarditis (IE) is controversial. We therefore sought to investigate outcomes among IVDUs after surgery for IE.

Methods We retrospectively reviewed all 192 consecutive patients who underwent an operation for IE between 2005 and 2016 in the Helsinki University Hospital. Forty-seven patients (24.5%) were IVDUs and 145 (75.5%) were non-IVDUs. Mortality and reinfection and reoperation rates were evaluated.

Results IVDUs were younger (29.9 vs. 63.8 years, p < 0.001) and had less cardiovascular risk factors and lower EuroSCORE II (4.3 vs. 7.3%, p < 0.001), but Staphylococcus aureus infection (66.0 vs. 23.4%, p < 0.001), tricuspid valve endocarditis (34.0 vs. 2.8%, p < 0.001), and liver disease (63.8 vs. 2.8%, p < 0.001) occurred more often in IVDUs than in non-IVDUs. Thirty-day mortality of IVDUs was 8.5% and that of non-IVDUs was 6.9% (p = 0.711). Survival of IVDUs at 5 years was 70.8 ± 7.4% and survival of non-IVDUs was 67.9 ± 4.7% (p = 0.678). Relative to an age- and sex-matched general population, IVDUs had 58.6 (95% confidence interval [CI]: 33.7–101.9; p < 0.001) and non-IVUD 4.4 (95% CI: 3.1–6.2; p < 0.001) standardized mortality ratio. IVDUs had a higher reinfection rate at 5 years (25.8 ± 7.7% vs. 3.0 ± 1.7%, p < 0.001) and a higher early reoperation rate than non-IVDUs (10.6 vs. 1.4%, p = 0.003).

Conclusions IVDUs and non-IVDUs had comparable survival at 5 years, but IVDUs had a very significantly increased risk of death in comparison to an age- and sex-matched general population. IVDUs had higher reinfection and early reoperation rates. Survival was poor after medically treated reinfection.

Keywords

endocarditis - heart valve surgery - outcomes (includes mortality and morbidity)


Publication History

Received: 01 September 2020

Accepted: 28 January 2021

Article published online:
27 June 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
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