Objectives: Evaluate surgical results in patients with infective endocarditis (IE) in critical preoperative state (CPS) as defined by the EuroSCORE
Methods: Retrospective analysis of 192 patients (1999-2007) undergoing cardiac surgery for IE, as defined by the Duke Criteria. Forty-four patients were in CPS (25 intubated, 12 intubated + i.v. inotropes, 7 others). The remaining 148 patients comprised the noCPS group. Survival analysis and logistic regression have been used.
Results: Mean age was 50.7±16.1 years in the CPS group (75% female [33/44]) and 52.7±17.1 years in the noCPS group (64.9% female [96/148]). Additive EuroSCOREs differed significantly (CPS: 12.3±3.1; noCPS: 8.8±2.9; p<0.001). Major perioperative complications were higher in the CPS group (OR 4.75; IC95% 2.1-10.9, p<0.001) and the CPS patients required more re-operations (OR 3.1; IC95% 1.1-8.3, p<0.05). Perioperative mortality did not differ significantly between the CPS and noCPS (CPS: 15.9% [7/44]; noCPS: 7.4% [11/148]; OR 2.4; IC95% 0.9-6.5, p=0.098), nor did 1- and 5-year survivals (figure). The mean follow-up was 42.7±5.6 months in the CPS group and 38.9±2.9 months in the noCPS group. Systolic pulmonary arterial pressure >60mmHg, ejection fraction <50% and moderate to severe tricuspid regurgitation were strong predictors of perioperative mortality, in univariate and multivariate analyses (p<0.001, R2=0.57).
Conclusions: Patients undergoing surgery for IE in CPS have a higher risk of major complications and late re-operations to those not in CPS, but similar midterm survival. This study suggests that surgery for IE should not be denied based on CPS considering the adequate outcomes of the patients surviving the operation.
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