Surgical outcomes of infective endocarditis in pediatrics: Moving the needle to a contemporary,multidisciplinary approach
Affiliation:
1. Department of Cardiothoracic Surgery, Nationwide Children''s Hospital, Columbus, Ohio;2. The Ohio State University, Columbus, Ohio;3. Division of Cardiology, The Heart Center, Nationwide Children''s Hospital, Columbus, Ohio;4. Biostatistics Resource, Nationwide Children''s Hospital, Columbus, Ohio;1. Department of Cardiac Surgery, Royal Children''s Hospital, Melbourne, Australia;2. Department of Paediatrics, University of Melbourne, Melbourne, Australia;3. Heart Research Group, Murdoch Children''s Research Institute, Melbourne, Australia;4. Melbourne Children''s Centre for Cardiovascular Genomics and Regenerative Medicine, Melbourne, Australia;1. Division of Pediatric Cardiac Surgery, Stanford University School of Medicine and Lucile Packard Children''s Hospital Stanford, Stanford, Calif;2. Division of Pediatric Cardiology, Stanford University School of Medicine and Lucile Packard Children''s Hospital Stanford, Stanford, Calif;1. Department of Cardiothoracic Surgery, Royal Children''s Hospital, Melbourne, Australia;2. Department of Paediatrics, University of Melbourne, Melbourne, Australia;3. Heart Research Group, Murdoch Children''s Research Institute, Melbourne, Australia;4. Department of Cardiology, Royal Children''s Hospital, Melbourne, Australia;5. Melbourne Centre for Cardiovascular Genomics and Regenerative Medicine, Melbourne, Australia;1. Department of Surgery, Allegheny General Hospital, Pittsburgh, Pa;2. Division of Cardiology, Department of Pediatrics, Texas Children''s Hospital, Houston, Tex;3. Division of Congenital Heart Surgery, Department of Surgery, Texas Children''s Hospital, Houston, Tex;1. Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, Israel;2. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel;3. Department of Cardiothoracic Surgery, Rabin Medical Center, Petah Tikva, Israel;4. Cedars-Sinai Heart Institute and David Geffen School of Medicine at the University of California, Los Angeles, Calif
Abstract:
BackgroundInfective endocarditis (IE) is an uncommon disease in children that, when present, is accompanied by significant morbidity and mortality. The presence of congenital heart disease often complicates management. The aim of the present study is to describe the characteristics and outcomes of children undergoing surgery for IE.MethodsA retrospective chart review from 2004 to 2020 was conducted to identify consecutive patients younger than age 20 years with IE undergoing surgery.ResultsA total of 94 patients with IE were identified, of whom 47 underwent surgery at a median age of 16.7 years. Thirty-one patients (65.95%) had congenital heart disease. Vegetation and embolic phenomena occurred in 41 and 29 patients (87.23% and 61.7%), respectively, with the brain as most common location (57.1%). Native valve involvement had a greater tendency to embolize (P < .001). Staphylococcus spp was the most common organism (49%). The mitral valve was the most affected (31.9%). Seven (14.9%) patients had multivalvar involvement and valve replacement was the most common procedure performed (37 patients; 78.7%). There were 3 operative deaths (6.4%). Median length of hospital stay was 21 days. Risk factors for prolonged hospital stay were time to surgery in days (P < .001) and native valvar involvement (P = .05). Five patients (10.6%) had postoperative recurrent IE. Survival at 1 and 5 years was 93.6% and 89.4%, respectively.ConclusionsChildren with IE can undergo surgery with acceptable results. The morbidity, but not mortality, is driven by embolic complications. Staphylococcus spp and native valve involvement are significant risk factors.Video Abstract
