Results of surgical treatment of infective endocarditis complicated by acute heart failure

Objective. To evaluate the results of surgical treatment of infective endocarditis complicated by acute heart failure. Materials and methods. The clinical data of 72 patients with infective endocarditis complicated by preoperative acute heart failure who underwent cardiac surgery at the Amosov National Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine from 01.01.2019 to 30.12.2022 were studied. All patients were assigned to functional class IV according to the functional classification of the New York Heart Association. Results. The average duration of infective endocarditis from its first signs (hyperthermia above 38 °C) to diagnosis was 2 months (2; 4 months). Among the causes of infective endocarditis, bronchopulmonary diseases dominated – 24 (33.3%) observations, general surgical interventions – 7 (9.7%) and hospital infection – 7 (9.7%). Urologic surgical interventions caused the development of infective endocarditis in 6 (8.3%) patients, hypothermia in 4 (5.6%), drug addiction in 4 (5.6%), and dental procedures in 1 (1.4%) patient. In 19 (26.4%) patients, the causes of infective endocarditis were not established. In 62 (86.1%) patients, a multi–valve correction was performed, and in 10 (13.9%) – a single–valve correction. The most common were two main options: aortic valve prosthetics in combination with mitral and tricuspid valve surgery in 13 (18.1%) patients and mitral and tricuspid valve surgery in 14 (19.4%) patients. Surgical intervention for combined lesions of the valvular apparatus of the left and right heart was performed in 51 (70.8%) patients with infective endocarditis complicated by acute heart failure. Frequent intracardiac abscessing – in 20 (27.8%) patients with aortic valve lesions and in 9 (12.5%) patients with mitral valve lesions – indicated a high rate of extensive infection spread. Hospital mortality in the surgical treatment of infective endocarditis complicated by acute heart failure was 13.9%. 10 patients died. Conclusions. In 96.1% of patients with infective endocarditis complicated by preoperative acute heart failure, multivalve surgical correction was performed. In the initial acute heart failure in the setting of infective endocarditis, intracardiac abscessing was often recorded: 27.8% in aortic valve lesions and 12.5% in mitral valve lesions. Hospital mortality in the surgical treatment of infective endocarditis complicated by preoperative acute heart failure was 13.9%.