Authors

• Davor Barić — University Hospital Dubrava, Zagreb, Croatia — ORCID: 0000-0001-5955-0275
• Gloria Šestan — University Hospital Dubrava, Zagreb, Croatia — ORCID: 0000-0002-6245-5508
• Daniel Unić — University Hospital Dubrava, Zagreb, Croatia — ORCID: 0000-0003-2740-4067
• Robert Blažeković — University Hospital Dubrava, Zagreb, Croatia
• Josip Varvodić — University Hospital Dubrava, Zagreb, Croatia
• Marko Kušurin — University Hospital Dubrava, Zagreb, Croatia — ORCID: 0000-0001-5690-9924
• Dubravka Šušnjar — University Hospital Dubrava, Zagreb, Croatia — ORCID: 0000-0002-9644-9739
• Savica Gjorgjievska — University Hospital Dubrava, Zagreb, Croatia — ORCID: 0000-0002-4304-1852
• Nikola Slišković — University Hospital Dubrava, Zagreb, Croatia
• Igor Rudež — University Hospital Dubrava, Zagreb, Croatia — ORCID: 0000-0002-7735-6721

Keywords

infective endocarditis, cardiac surgery, surgical indications, acute

DOI

Full Text

**Background**: Timing of surgery continues to be one of the most challenging point of interest in management of patients with acute infective endocarditis (IE). Recent guidelines recommend early surgery in most patients as soon as indication is met. (1, 2) We present our 26-year experience of surgical treatment for IE with additional analysis of optimal timing of surgery. **Methods and Results**: An analysis of prospectively collected data of 325 adult patients who underwent surgery due to acute IE between 1996 and 2022 at our institution was performed. Isolated aortic valve IE was observed in 48%, isolated mitral valve IE in 32%, multiple valves were affected in 12% and right-sided valves involved in 7% of cases. There were 12% of patients with previous cardiac operations and 10% of patients with prosthetic valve endocarditis. Perioperative mortality was 10.7% (35/325). An additional analysis was performed on subgroup of 155 consecutive patients with supplementary data available. They were divided in 2 groups: patients operated early (up to 14 days of diagnosis) or late (after 14 days). Patients in early-surgery group were significantly younger, had better renal function, lower incidence of neurologic impairment and higher incidence of perivalvular abscess. There was an observed tendency of higher valve repair rate in late-surgery group. Difference in perioperative mortality was observed (5.3% early-surgery group; 10.0% late-surgery group) but was not significant (p=0.277). **Conclusion**: The current evidence and our experience suggests survival benefits in early operated patients with IE, if an urgent indication for early surgery is present. To delay surgery for prolongation of preoperative antibiotic therapy is likely not going to lead to any additional patient benefit.

Literature

1. Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del Zotti F, 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 November 21;36(44):3075–128. https://doi.org/10.1093/eurheartj/ehv319
2. Baddour LM, Wilson WR, Bayer AS, Fowler VG, Tleyjeh IM, Rybak MJ, 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 October 13;132(15):1435–86. https://doi.org/10.1161/CIR.0000000000000296