Abstract
Background/aim of study: Infective endocarditis (IE) morbidity
and mortality remains high. In most studies, endocarditis lesions found
during surgery are not extensively described. The aim of this study was
to register and describe endocarditis lesions found during surgery; find
predictors of morbidity and mortality and correlate lesions found in
echocardiogram vs. surgery. Methods: One hundred consecutive
cases with endocarditis lesions seen during surgery were included
between june 2014 and august 2018. Pathological lesions were coded
prospectively using a coding form published by Pettersson et al. Other
data were collected retrospectively. Results: Prosthetic
endocarditis accounted for 23% of cases. Embolic events had occurred in
41% of cases, mainly to the brain (22%). The most frequent lesions
found in echocardiogram were vegetations (77%). Vegetations and valve
integrity anomalies were the main lesions described during surgery (70%
and 71% respectively). Invasion was present in 39% of patients.
In-hospital mortality was 9%. In univariable analysis, predictors of
early mortality included chronic kidney disease (p= 0.005), prosthetic
endocarditis (p< 0.001), Euroscore II (p< 0.001) and
valve integrity anomalies (p= 0.016). Predictors of embolic events
included aortic valve vegetations seen during surgery (p= 0.026).
Sensitivity and specificity of echocardiogram findings for
identification of vegetations were 84% and 40%, for valve integrity
anomalies 42% and 97% and for invasion 54% and 95% respectively.
Conclusions: Diversity of lesions found in endocarditis
preclude obtaining significant predictors of morbidity or mortality with
small numbers of patients. Echocardiogram lacks sensitivity for valve
integrity anomalies and invasion, but is highly specific.