Surgical treatment of infective endocarditis in active intravenous drug users: A justified procedure?

Alexander Weymann, Tobias Borst, Aron Frederik Popov, Anton Sabashnikov, Christopher Bowles, Bastian Schmack, Gabor Veres, Nicole Chaimow, Andre R. Simon, Matthias Karck, Gábor Szabo

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16 Citations (Scopus)

Abstract

Background: Infective endocarditis is a life threatening complication of intravenous drug abuse, which continues to be a major burden with inadequately characterised long-term outcomes. We reviewed our institutional experience of surgical treatment of infective endocarditis in active intravenous drug abusers with the aim of identifying the determinants long-term outcome of this distinct subgroup of infective endocarditis patients .Methods: A total of 451 patients underwent surgery for infective endocarditis between January 1993 and July 2013 at the University Hospital of Heidelberg. Of these patients, 20 (7 female, mean age 35 ± 7.7 years) underwent surgery for infective endocarditis with a history of active intravenous drug abuse. Mean follow-up was 2504 ± 1842 days. Results: Staphylococcus aureus was the most common pathogen detected in preoperative blood cultures. Two patients (10%) died before postoperative day 30. Survival at 1, 5 and 10 years was 90%, 85% and 85%, respectively. Freedom from reoperation was 100%. Higher NYHA functional class, higher EuroSCORE II, HIV infection, longer operating time, postoperative fever and higher requirement for red blood cell transfusion were associated with 90-day mortality. Conclusions: In active intravenous drug abusers, surgical treatment for infective endocarditis should be performed as extensively as possible and be followed by an aggressive postoperative antibiotic therapy to avoid high mortality. Early surgical intervention is advisable in patients with precipitous cardiac deterioration and under conditions of staphylococcal endocarditis. However, larger studies are necessary to confirm our preliminary results.

Original languageEnglish
Article number58
JournalJournal of cardiothoracic surgery
Volume9
Issue number1
DOIs
Publication statusPublished - Mar 24 2014

Keywords

  • Cardiac surgery
  • Heart valve
  • Infective endocarditis
  • Intravenous drug abuse

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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    Weymann, A., Borst, T., Popov, A. F., Sabashnikov, A., Bowles, C., Schmack, B., Veres, G., Chaimow, N., Simon, A. R., Karck, M., & Szabo, G. (2014). Surgical treatment of infective endocarditis in active intravenous drug users: A justified procedure? Journal of cardiothoracic surgery, 9(1), [58]. https://doi.org/10.1186/1749-8090-9-58