Analysis of Surgical Treatment Outcomes in 709 Cases of Infective Endocarditis

To review the clinical characteristics, short-term outcomes, and risk factors of patients with infective endocarditis(IE) who underwent surgical treatment at a single center, and to summarize treatment experience.

Consecutive patients diagnosed with IE who underwent cardiac surgery at the Department of Cardiac Surgery, Peking Union Medical College Hospital between May 2012 and June 2024 were enrolled. Statistical analyses were performed on their baseline characteristics, comorbidities, IE predisposing factors, surgical indications, pathogen distribution, surgical strategies, short-term outcomes, and associated risk factors.

A total of 709 IE patients meeting the inclusion and exclusion criteria were included. IE involved left-sided valves in 85.3% of cases. The median age was 48(35, 58) years, and 68.0% were male. Prosthetic valve endocarditis accounted for 8.7%. Patients with left-sided IE had a higher prevalence of comorbidities. Streptococcus was the causative pathogen in 43.2% of patients, while right-sided IE was more frequently associated with Staphylococcus aureus. Underlying structural heart abnormalities were present in 66.4% of patients. Preoperative heart failure occurred in 32.7% of patients, 90.1% had valvular dysfunction, 11.3% underwent emergency surgery, and 24.8% had preoperative neurological complications. Valve replacement was performed in 95.3% of patients with aortic valve involvement, whereas the mitral valve repair rate was 55.4%. The in-hospital mortality rate was 3.5%, and the rate of in-hospital composite adverse events was 13.5%. Preoperative NYHA class Ⅲ-Ⅳ(OR=5.24, 95% CI: 2.01-13.71), infectious pancytopenia(OR=3.32, 95% CI: 1.29-8.51), regional cerebral infarction(OR=4.09, 95% CI: 1.34-12.49), and preoperative fever(OR=2.34, 95% CI: 1.00-5.47) were identified as independent risk factors for in-hospital mortality. Every 10-year increase in age(OR=1.20, 95% CI: 1.02-1.40), Staphylococcus aureus infection(OR=2.15, 95% CI: 1.13-4.11), preoperative unstable vital signs(OR=2.29, 95% CI: 1.26-4.17), NYHA class Ⅲ-Ⅳ(OR=3.07, 95% CI: 1.84-5.10), and history of prior cardiac surgery(OR=2.10, 95% CI: 1.12-3.96) were independent risk factors for the composite endpoint event.

Significant differences in pathogen distribution were observed between patients with left-sided and right-sided IE. Heart failure was identified as an independent risk factor for both perioperative mortality and adverse outcomes in surgically treated patients. Through strict timing of surgical intervention and optimized perioperative management, surgical treatment may effectively reduce mortality and improve prognosis in patients with IE.