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Short- and long-term outcomes of surgery for active infective endocarditis: a Tunisian experience

^a Department of Cardiology, University Hospital Hédi Chaker, Sfax, Tunisia
^b Department of Infectious Diseases, University Hospital Hédi Chaker, Sfax, Tunisia
^c Department of Microbiology, University Hospital Habib Bourguiba, Sfax, Tunisia
^d Department of Cardiovascular Surgery, University Hospital Habib Bourguiba, Sfax, Tunisia

*Corresponding author. Tel.: +21674292165; fax: +21674243992.

E-mail address: sofienerek{at}yahoo.fr (S. Rekik).

From January 1997 to December 2006, all patients with a Duke criteria-based definite diagnosis of infective endocarditis (IE) operated on during the active phase in a Tunisian high volume tertiary-care centre were included. Among the 186 patients with IE identified during the study period, 88 (48.35%) required surgery in the active phase. Mean age was 34.9 years, 54 (61.4%) were men. The infected valve was native in 70 cases (79.5%) and prosthetic in 18 (20.5%). Streptococcus sp. were the most common causative microorganisms. The most frequent indication for operation was congestive heart failure. There were 24 in-hospital deaths (27.27% early mortality). By multivariate analysis, severe congestive heart failure (HR=13.82, 95% CI [3.38–38.15], P<0.001) and large >15 mm vegetations (HR=6.02, 95% CI [1.48–18.52], P=0.03) were predictive of in-hospital mortality. Survivors were followed-up from 3 to 120 months, mean of 28.6. Actuarial 5- and 10-year survivals free from the combined endpoint of recurrent IE, cardiovascular death and late surgery in survivors were 69±5% and 63±7%, respectively. In conclusion, despite medical progress, surgery for endocarditis in Tunisia remains challenging and yields high mortality rates. Severe heart failure is the most powerful predictor of mortality. Long-term outcome is, however, satisfactory.

Key Words: Infective endocarditis; Mortality; Predictors