Thorac Cardiovasc Surg 2022; 70(S 01): S1-S61
DOI: 10.1055/s-0042-1742870
Oral and Short Presentations
Monday, February 21
Failing Heart Valves: Endocarditis and Degeneration

Increased Incidence of Mitral Valve and Streptococcus-Related Infective Endocarditis after the 2009 ESC Prophylaxis Guideline Modifications

C. Weber
1   University Hospital of Cologne, Köln, Deutschland
,
M. Luehr
2   University Hospital of Cologne, Cologne, Deutschland
,
G. Petrov
3   Klinikum Dortmund GmbH Herzchirurgische Klinik (Klinik für Herz- und Gefäßchirurgie), Dortmund, Deutschland
,
M. Misfeld
4   Leipzig Heart Center, Leipzig, Deutschland
,
P. Akhyari
5   University Hospital Duesseldorf, Düsseldorf, Deutschland
,
S. M. Tugtekin
6   Herzzentrum Dresden, Dresden University of Technology, Dresden, Deutschland
,
M. Diab
7   Friedrich-Schiller-Universität Jena, Jena, Deutschland
,
S. Saha
8   Department of Cardiac Surgery, Ludwig-Maximilian University Munich, Munich, Deutschland
,
A. Elderia
2   University Hospital of Cologne, Cologne, Deutschland
,
A. Lichtenberg
5   University Hospital Duesseldorf, Düsseldorf, Deutschland
,
C. Hagl
9   Department of Cardiac Surgery, Ludwig-Maximilian University Munich, Munich, Deutschland
,
T. Doenst
7   Friedrich-Schiller-Universität Jena, Jena, Deutschland
,
K. Matschke
6   Herzzentrum Dresden, Dresden University of Technology, Dresden, Deutschland
,
M. A. Borger
4   Leipzig Heart Center, Leipzig, Deutschland
,
T. Wahlers
2   University Hospital of Cologne, Cologne, Deutschland
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Background: In 2009, updated European Society of Cardiology (ESC) guidelines on the prevention, diagnosis, and treatment of infective endocarditis (IE) were released, that restricted the use of antibiotic prophylaxis only for high-risk patients. Our aim was to analyze the effect of the restrictive antibiotic regime on the incidence and manifestation of surgically treated IE before and after the guideline change.

Method: We retrospectively analyzed data of 4,917 patients undergoing valve surgery for IE between 1994 and 2018 in six German cardiac surgery centers. Potential risk factors for 30-day mortality were assessed using logistic regression. Interrupted time series regression was used to evaluate the effect of the guideline change on the manifestation of IE.

Results: A total of 2014 patients (41%) underwent surgery before and 2,903 patients (59%) after the guideline change. After 2009, patients were older (67.0 [56.0–74.0] vs. 64.0 [52.0–71.0]; p < 0.001), presented with more comorbidities, such as hypertension (56.9 vs. 41.7%; p < 0.001), diabetes (27.4 vs. 24.4%; p = 0.020), peripheral artery disease (8.5 vs. 6.5%; p = 0.011), and preoperative acute kidney injury (42.8 vs. 31.9%; p < 0.001). Patients had worse clinical outcomes with respect to 30-day (18.1 vs. 14.3%; p = 0.001) and 1-year mortality (37.1 vs. 29.1%; p < 0.001). We observed an increase of Streptococcus-related IE (p = 0.002) after the guideline change and an increase of mitral valve IE (p = 0.035).

Conclusion: Since 2009, there has been a significant increase in the incidence of mitral valve IE and Streptococcus-related IE. Patients undergoing surgery for IE after the guideline change in 2009 present with more comorbidities, which contribute to high mortality rates. (Parts of this study have been prepublished.)



Publication History

Article published online:
03 February 2022

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