The Role of Surgery in Contemporary Infective Endocarditis.

OBJECTIVES: Infective endocarditis (IE) is a multifaceted disease and its treatment can often be challenging. Furthermore, along with a rising incidence, the clinical manifestation of IE has changed over the years. This study analyses the interdisciplinary endocarditis team management of IE in a tertiary care hospital.

METHODS: We reviewed the patients who were admitted for IE at our institution between January 2012 and December 2021. Risk estimation was performed by calculating the EuroSCORE II and the EndoSCORE.

RESULTS: A total of 812 consecutive patients were admitted to our centre for IE. Among these patients, 249 patients (30.7%) underwent conservative treatment for IE (Group C) and 563 patients (69.3%) underwent surgery (Group S). The EuroSCORE II was 5.5 (2.6-10.1) in Group C and 5.1 (2.5-10.7) in group S, whereas the EndoSCORE was 7.6 (6.9-19.6) in Group C and 12.3 (6.9-19.5) in Group S. The Duke criteria were not met in 297 patients (36.6%) and patients not meeting the Duke criteria were more often treated conservatively. A higher number of patients suffering from TAVR-endocarditis and tricuspid valve endocarditis were treated conservatively. Whereas patients with aortic valve endocarditis were treated surgically more often.

CONCLUSIONS: Infective endocarditis is a multifaceted disease, which requires a specialized interdisciplinary approach. Decisions on treatment modalities should be made on a case-to-case basis in an endocarditis team setting. In addition to treatment modality, adequate consideration should be given to the pathogen causing IE and the extent of IE.