Original article
Adult cardiac
Survival of Surgically Treated Infective Endocarditis: A Comparison With the General Dutch Population

https://doi.org/10.1016/j.athoracsur.2011.02.007Get rights and content

Background

Infective endocarditis (IE) remains associated with high in-hospital and long-term mortality. The outcome of patients with IE who are operated on has never been put into perspective by comparing it to the age-matched and gender-matched general population. The aim of the present study was to evaluate the long-term mortality of patients with IE who undergo operation in relation to the age-matched and gender-matched general population.

Methods

A retrospective observational cohort study of 138 patients with IE who underwent consecutive operations (1998–2007) was conducted. Cumulative survival was analyzed using the Kaplan-Meier method. Comparison of patient survival with the general population was done using the Dutch population life table. The standardized mortality ratio was used to assess the degree of late deaths.

Results

The observed in-hospital mortality risk was 10.9%. The observed long-term survival was 85% (95% confidence interval, 78% to 90%), 74% (95% confidence interval, 65% to 79%), 71% (95% confidence interval, 62% to 78%) after 1, 5, and 10 years, respectively. Age-matched and gender-matched survival in the general population was 99%, 93%, and 80% after a follow-up period of 1, 5, and 10 years, respectively. The standardized mortality ratio was 0.99 (95% confidence interval, 0.67 to 1.31).

Conclusions

Although mortality of IE patients who have undergone operation remains considerable during the immediate postoperative period, the mortality of hospital survivors is, with increasing follow-up time, comparable with the general population.

Section snippets

Study Population

From January 1998 to December 2007, a total of 191 patients were treated conservatively or underwent a surgical procedure for IE at our institution. All adult patients (n = 138) who consecutively underwent a cardiac surgical procedure for IE were included. Only patients having definite IE according to the modified Duke criteria were included in the study [10]. Erasmus Medical Centre is a tertiary care university hospital and serves as a referral center for other local hospitals. Of 138 patients

Results

Baseline characteristics of the 138 patients with definite IE are shown in Table 1. The vast majority concerned left-sided heart valves (Table 2). The indications for performing an urgent operation (22 patients [15.9%]) were heart failure unresponsive to medication (n = 15) and vegetation or repeated embolism (n = 7). The mean time between (first) admission for IE and operation was 17 days (range, 0 to 330 days).

Comment

Mortality of IE patients who have undergone operations is considerable during the immediate postoperative period. Nevertheless, our study shows that patients who survive this immediate period have a relatively low late mortality rate. Although hospital survivors still had a higher mortality hazard in the first year [18], the annualized mortality hazard after the first year decreased by approximately 50%. With increasing follow-up time, the survival of hospital survivors becomes comparable to

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