555. Outcomes in Patients Following Surgery for Infective Endocarditis: The Contemporay Cleveland Clinic Experience
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: In devising a treatment plan for patients with infective endocarditis (IE), risk of mortality and complications with medical therapy alone have to be balanced against those with surgery. Decision-making can be improved by knowledge of outcomes in patients undergoing surgery for IE in experienced cardiac centers.
Objective: To report contemporary outcomes in patients undergoing cardiac surgery for infectious endocarditis (IE) at Cleveland Clinic.
Methods: From 1/2003 to 1/2008, 509 patients underwent surgical treatment of native valve (NVE) or prosthetic valve (PVE) IE. Data abstracted from prospective registries and medical records included demographics, microbiology, operative procedure, and surgical outcomes (Society for Thoracic Surgery National Database definitions).
Results: 308 (61%) had NVE, and 201 (39%) had PVE, with or without other NVE. Mean age was 56 yrs and 70% were men. Isolated aortic valve (39%), isolated mitral valve (21%), and combined aortic and mitral (19%) procedures were most common. 21% had concomitant coronary artery bypass grafting. Most common pathogens were CN staphylococci (24%); S. aureus (23%), Streptococcus sp. (18%), and Enterococci (15%). Time from admission to cardiac surgery was 7.6 days. Postoperative stay was 15.3 days. Overall hospital mortality was 9.2%. Complications included reoperation for bleeding (7.5%), respiratory insufficiency (17%), renal failure (6.5%), and stroke (3.1%). Patients undergoing surgery for PVE vs. NVE were likely to have more preoperative heart failure (60% vs. 48%, P<.01), more postoperative renal failure (13% vs. 4.2%, P=.03), and higher hospital mortality (15% vs. 6.5%, P=.02).
Conclusions: Approximately 100 patients undergo surgical treatment of IE at our institution annually. Patients with PVE have a significantly higher risk for post operative renal failure and hospital death when compared to patients with native valve IE.
Tom Fraser, MD1, Steven Gordon, MD, FIDSA2, Alice Kim, MD3, Manesh Manne, MD1, Jose Navia, MD3, Edward Nowicki, MD1, Gosta Pettersson, MD1, Joseph Sabik, MD1, Nabin Shrestha, MD1 and  M. Manne, None..
T. Fraser, None..
J. Navia, None..
N. Shrestha, None..
A. Kim, None..
E. Nowicki, None..
J. Sabik, None..
S. M. Gordon, None..
G. Pettersson, None., (1)Cleveland Clinic Foundation, Cleveland, OH, (2)Infectious Disease, Cleveland Clinic, Cleveland, OH, (3)Cleveland Clinic, Cleveland, OH