Outcomes after Surgical Treatment of Infectious Endocarditis with Partial or Severe Destruction of the Heart Skeleton

Background: Infectious endocarditis (IE) remains a critical condition despite all medical advances in the last decades. IE is still a dreaded disease, especially in patients with advanced affection of the heart skeleton. The aim of this study was to analyze the incidence and outcomes of patients after complex surgical treatment requiring a patch reconstruction due to an extensive and destructive IE.

Methods: All consecutive adult patients who underwent a complex cardiac surgery requiring a patch reconstruction due to an extensive and destructive IE at the University Hospital Frankfurt/Main between January 2004 and August 2024 were included in this study. The primary endpoint was 30-mortality and survival. Secondary endpoints were the overall incidence in relation to risk factors and severe peri-/postoperative complications (re-exploration due to bleeding, stroke, reoperation, etc.).

Results: During the above-mentioned time period, 757 patients were operated due to IE. Out of them 97 patients (13%) required a complex patch reconstruction due to a partial or severe affection of the heart skeleton. The median age was 67 (IQR 16) years; 66 (68%) were female. Forty-one were redo procedures after previous cardiac surgery. Abscess formation was diagnosed in 78% (n = 76). The localization of the IE was left-sided in 97% (n = 94): aortic valve in 81% (n = 79) and mitral valve in 52% (n = 50). Right-sided IE occurred in 10% (n = 10): tricuspid valve in 9 patients and only 1 patient suffered from pulmonary IE. In 40 (41%) patients the aorto-mitral continuity or left ventricular outflow tract was affected. Combined procedures were performed in 85 patients (87.6%). In 60% (n = 58) single valve surgery, in 32% (n = 31) double valve surgery, and in 6 patients (6%) triple valve surgery was performed. A Bentall-De Bono operation was performed in 48% (n = 47) patients. A commando or hemi-commando operation was performed in 19 patients. Concomitant coronary artery bypass grafting was required in 18 patients. 30-day mortality was 23% (n = 22) and 1-year mortality was 41% (n = 39). Further follow-up will be performed.

Conclusion: Advanced IE with partial or severe destruction of the heart skeleton needs an extensive surgical repair using a patch reconstruction and multiple valve surgery in the majority of the cases. This is associated with significantly increased morbidity and mortality. Therefore, an early diagnosis and initiation of the adequate treatment are particularly important.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
11 February 2025