P433Surgery in infective endocarditis : epidemiologic and prognotic factors


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Abstract

Introduction: Roughly 50% of infective endocarditis (IE) require surgery during its active phase. The creation of multidisciplinar units has boosted the surgical approach of this disease.Objectives: to describe the demographic and epidemiologic characteristics of patientes who underwent a surgical treatment for IE in our center and their subsequent evolution.Methods: prospective observational study. 244 patients were included following Duke modified criteria, from January 2003 to December 2010. 124 patients (52%) required surgery during the active phase of IE.Results: 67% of the patients were men, mean age 60±14 years old, mean logistic EuroScore 20,7%. Main valve involvement was single aortic endocarditis (73,5%), and by groups in order of prevalence: native left valve 78 (63%), prosthetic left valve 36 (29%), device-related 6 (4.8%) and right valve involvement 4 (3.2%). Most often surgical indication was persistent heart failure due or severe vavular regurgitation (60%). There were 57 (46%) biological valve replacements. Mean delay from diagnosis to surgery was 11,9 ± 8 days. Global mortality of IE was 32%, being 20% in the surgical group. We found significant differences in in-hospital mortality in the following variables: IE evolution time (p=0,003), EuroScore puntuation (p=0,012), leukocytosis (p=0,003), liver disease (p=0,005), early prosthetic endocarditis (p=0,016) and septic shock (p=0,001).Conclusions: more than half of IE episodes required surgery, being heart failure or severe valvular regurgitation the main indication. Surgical IE mortality is lower than that of the global serie, despite the elevated surgical risk. The characteristics associated to an increase in mortality are: EuroScore value, leukocytosis, early prosthetic IE, liver disease, and the appearance of septic shock.

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