Outcomes of surgery for infective endocarditis in children: A 30-year experience

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 158; no. 5; pp. 1399 - 1409
• Main Authors: Khoo, Brandon, Buratto, Edward, Fricke, Tyson A., Gelbart, Ben, Brizard, Christian P., Brink, Johann, d'Udekem, Yves, Konstantinov, Igor E.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2019
• Subjects: Adolescent; Anti-Bacterial Agents - therapeutic use; Australia - epidemiology; Cardiac Surgical Procedures - adverse effects; Cardiac Surgical Procedures - methods; Cardiac Surgical Procedures - statistics & numerical data; Child; Child, Preschool; Endocarditis - diagnosis; Endocarditis - microbiology; Endocarditis - mortality; Endocarditis - surgery; Female; Heart Defects, Congenital - complications; Heart Defects, Congenital - epidemiology; Heart Valve Diseases - diagnosis; Heart Valve Diseases - epidemiology; Heart Valve Diseases - surgery; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - methods; Humans; infective endocarditis; Male; Medical Records, Problem-Oriented - statistics & numerical data; mortality; outcomes; pediatric; Prognosis; reoperation; Risk Factors; Staphylococcal Infections - diagnosis; Staphylococcal Infections - therapy; surgery; Survivors - statistics & numerical data; timing; valve replacement; Australia; valve replacement; CoNS; infective endocarditis; outcomes; timing; mortality; reoperation; IE; CHD; surgery; pediatric
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2019.06.024

Infective endocarditis (IE) is rare in children. Limited data have been reported on long-term outcomes of children who undergo surgery for IE. Data were retrospectively obtained from medical records for all children who underwent surgery for IE. Between 1987 and 2017, 138 children with IE required surgery (mean age, 8.3 ± 6.5 years). The majority of children (80.4% [111 out of 138]) had underlying cardiac structural anomalies. Prior heart surgery was performed in 50.7% of patients (70 out of 138), including 19.6% (27 out of 138) who had valve replacement. Operative mortality was 5.8% (8 out of 138). Mean follow-up time was 9.7 ± 7.6 years. Long-term survival at 5 and 25 years was 91.5% (95% confidence interval, 85.1%-95.2%) and 79.1% (95% confidence interval, 66.3%-87.5%), respectively. Risk factors associated with death were: age (hazard ratio [HR], 0.88; P = .015), prosthetic valve IE (HR, 3.86; P = .02), coagulase-negative staphylococci (HR, 4.52; P = .015), increased duration of preoperative antibiotic therapy (HR, 1.02; P = .009), shock (HR, 3.68; P = .028), and aortic valve replacement (HR, 3.22; P = .044). In patients with left-sided IE, risk factors independently associated with death were heart failure (HR, 18.8; P = .025) and vegetation size adjusted to body surface area (HR, 1.06; P = .008). Freedom from recurrent endocarditis was 94.7% (95% confidence interval, 87.7%-97.8%) at 25 years. Children undergoing surgery for IE had good long-term survival and recurrence of IE was uncommon. Surgery during the active phase of endocarditis did not increase risk of mortality or reoperation. In patients with left-sided IE, vegetation size adjusted for patient body surface area was identified as a risk factor for death, and a useful indicator of prognosis.