Clinical features, echocardiographic findings and surgical aspects related to mortality on complicated endocarditis

Clinical features, echocardiographic findings and surgical aspects related to mortality on complicated endocarditis.

Infective endocarditis is a serious public health problem with high morbidity and mortality and considerable prevalence in our environment. The international guidelines on the diagnosis and treatment of endocarditis contemplate a series of clinical, paraclinical and echocardiographic criteria from which this entity is defined and recommendations for the study algorithm are indicated. The worldwide mortality is reported to be about 20%.

Identify the risk factors more frequently present on patients found with echocardiographic complications at time of endocarditis diagnosis at our centre and their post-surgical outcome. The knowledge of these factors may allowed a greater awareness of the possibility of endocarditis based on such characteristics, and in consequence could favours the timely treatment.

The study design is a retrospective cohort in a third level public hospital along 5 years, since the 1st of January 2019 to 31st of September 2023. The patient's data was took from the clinical records which include the surgical dictation of each procedure to compare the echocardiographic description against the intraoperative findings. Transthoracic echocardiogram and in specific cases even transesophagueal was performed using a Philips 7C model 01800 253 0446.

Also procedure most relevant aspects about haemodynamic conditions as well as eventualities during the surgery were reported and compare between patients who died in the post-surgery period.

A sample of 58 patients was collected, in which for every 5 cases of native endocarditis, 1 case of prosthetic endocarditis was documented in said period. The features of the studied population are described on the corresponding table. Local complications, surgery procedure and culture results are also exposed. However, the latter were not taken into account for the statistical analysis since in several cases it was not possible to obtain a microbial isolation. On 72% of the fatal cases local complications such as the presence of multiple vegetations, valve perforation, abscess in adjacent structures, fistulas, rupture of the chorda tendineae and rupture of the papillary muscle were documented.

Along 5 years overall mortality was about 43%, while the prosthetic endocarditis group had a mortality of 75%.