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Cardiothoracic Surgery |

Surgical Management of Infective Endocarditis in an Asian Population: An Analysis of Early and Midterm Outcomes

Philip, Yi Kit Pang, MBBS; Yoong Kong Sin, MBBS; Chong Hee Lim, MBBS; Teing Ee Tan, MBBS; See Lim Lim, MBBS; Yeong Phang Lim, MBBS; Victor, Tar Toong Chao, MBBS; Jang Wen Su, MBBS; Yeow Leng Chua, MBBS
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National Heart Centre, Singapore, Singapore


Chest. 2013;144(4_MeetingAbstracts):113A. doi:10.1378/chest.1703196
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Abstract

SESSION TITLE: Cardiac and Thoracic Surgery Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: To review our experience of surgical management of infective endocarditis (IE) and analyze the outcomes and prognostic factors associated with this condition.

METHODS: In a retrospective review from January 2000 to December 2012, 191 patients underwent surgery for IE as defined by the Duke criteria at our tertiary referral centre.

RESULTS: Mean age was 47.4 ± 14.9 years with 63.9% males. Native valve endocarditis was present in 177 patients (92.7%) and prosthetic valve endocarditis in 14 (7.3%). Sixty-three patients (33.0%) presented with embolic complications, with the brain being the most common site of embolism (13.1%). Streptococcus was the most common infective organism (41.9%), followed by Staphylococcus (19.4%). Eight-seven patients (45.5%) had active endocarditis at the time of surgery. The mitral valve was infected in 136 (71.2%), the aortic in 66 (34.6%), the tricuspid in 29 (15.2%) and multiple valves in 28 (14.7%). Tricuspid valve IE was more common in intravenous drug abusers (41.4% vs 4.3%, P<0.001). The most common indication for surgery was intractable cardiac failure. Four patients (2.1%) required implantation of a permanent pacemaker after surgery. Operative mortality within 30 days of surgery was 6.3%. Univariate analysis identified age, left ventricular ejection fraction, creatinine clearance, emergency operation, New York Heart Association (NYHA) class, active endocarditis, cerebral emboli, EuroSCORE II, re-exploration for bleeding, post-operative stroke, post-operative renal failure and renal replacement therapy (RRT) as predictors of operative mortality. Logistic multivariate analysis identified creatinine clearance and cerebral emboli as independent predictors of operative mortality. Overall 10-year survival and freedom from valve-related reoperation were 78.6% and 87.0% respectively. Pre-operative NYHA class, creatinine clearance and post-operative RRT were factors influencing midterm survival.

CONCLUSIONS: Surgery for IE is associated with acceptable early and midterm morbidity and mortality. Pre-operative creatinine clearance and cerebral emboli are predictors of early mortality. NYHA class, creatinine clearance and post-operative RRT are factors influencing midterm survival.

CLINICAL IMPLICATIONS: These factors identified may aid in prognostication of patients undergoing surgery for IE. The optimal timing for surgical intervention remains controversial.

DISCLOSURE: The following authors have nothing to disclose: Philip, Yi Kit Pang, Yoong Kong Sin, Chong Hee Lim, Teing Ee Tan, See Lim Lim, Yeong Phang Lim, Victor, Tar Toong Chao, Jang Wen Su, Yeow Leng Chua

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