Incidence, predictors and outcomes of infective endocarditis in a contemporary adult congenital heart disease population. (15th December 2017)

• Record Type: Journal Article
• Authors: Moore, Benjamin; Cao, Jacob; Kotchetkova, Irina; Celermajer, David S
• Is Part Of: International journal of cardiology. Volume 249(2017)
• Page Start: 161
• Page End: 165
• Publication Date: 2017-12-15
• Subjects: Adult congenital heart disease -- Infective endocarditis; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2017.08.035
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: The prevalence of congenital heart disease (CHD) in the adult population is steadily increasing. A substrate of prosthetic material and residual lesions, constantly evolving as surgical techniques change over time, predispose these patients to the potentially devastating complication of infective endocarditis (IE). Methods: We retrospectively reviewed 2935 patients in our adult CHD database for all cases of endocarditis between 1991 and 2016. Incidence, clinical course and predictors of outcomes were analysed. Results: We document 74 episodes in 62 patients, with an incidence of 0.9 cases/1000 patient years (py). IE was more common in complex CHD (1.4 cases/1000 py) and ventricular septal defects (VSDs) (1.9 cases/1000 py). Prosthetic material was involved in 47% and left-sided infection predominated (66%). The incidence in bicuspid aortic valves post aortic valve replacement (AVR) was significantly higher than in unoperated valves, being 1.8 and 1.1 cases/1000 patient years respectively. Streptococcus was the most frequently implicated causative organism (37%). Emboli occurred in 34% of cases with a cerebral predilection. 46% of patients required surgery during the admission for IE, most frequently to replace a severely regurgitant bicuspid aortic valve. Early endocarditis-related mortality was 15%, associated with cerebral emboli and acute renal failure. Conclusions: In a contemporary adult CHD cohort, those with complex underlying lesions, VSDs or an AVR were at higher risk for IE. Mortality remains substantial and is more likely in patients with cerebral emboli and/or acute renal failure.