Abstract 19585: Despite a Decline in Hospital Mortality Rates After Surgical Intervention, Long Term Survival Following Surgery for Endocarditis Remains Poor
Purpose: The resurgence of illicit drug use (IDU) in North America has been associated with an increased incidence of bacterial endocarditis (BE). The goal of this study was to characterize temporal trends of in hospital mortality and long-term survival among patients undergoing surgery for BE.
Methods: All patients undergoing valve surgery for BE between 2001-2014 (n=13,669) were identified from a prospectively maintained, multi-center regional registry. Data were collected on: patient characteristics, the frequency of BE surgery, hospital mortality, and long-term survival using Kaplan-Meier estimators. Outcomes were stratified in tertiles by time period. The median duration of follow-up for the series was 2.1 [IQR=0.1-6.0] years.
Results: The frequency of BE surgery in the study population was 5.5% (n=755). From 2001-2005 (4.9%) to 2011-2014 (7.1%) there was a significant rise in the incidence of BE surgery (p<0.001). The mean age of BE patients decreased over time (p=0.002) as did the rate of diabetes, kidney disease, recent MI and low ejection fraction. While overall hospital mortality declined significantly over time for BE patients from 16.1% in 2001-2005 to 6.1% in 2011-2014 (p<0.001), long-term survival did not improve (Figure). Survival was significantly worse for patients operated on in more recent years (3-year survival: 67% (2001-2005); 77% (2006-2010); 59% (2011-2014); p=0.019) (Figure). In a subset of data, the frequency of IDU among endocarditis cases doubled during 2011-2014 (p=0.019).
Conclusions: Despite a decrease in hospital mortality for BE valve surgery, long term survival remains poor and has declined over time. Our findings suggest that even with improvements in surgical outcomes, contemporary BE patients, who are younger and have higher rates of IDU, remain at high, long term risk of death.
Author Disclosures: J. McCullough: None. Y.R. Baribeau: None. A. Iribarne: None. B.J. Leavitt: None. E.M. Olmstead: None. C. Frumiento: None. R.D. Quinn: None. R.A. Boss, Jr.: None. C.S. Ross: None. A.W. DiScipio: None.
- © 2016 by American Heart Association, Inc.