IS THE SURGICAL OPTION TOO CHALLENGING IN CASE OF MULTIVALVULAR INFECTIVE ENDOCARDITIS?

Background: Double-valve infective endocarditis (DVIE) accounts for 15–20% of all endocarditis. The mechanisms of extension of the infection differ as in left-sided DVIE, there is often a primary focus in aortic valve which then involves the mitral valve. On other hands bilateral endocarditis is often the consequence of the infection’s haematogenous spread. Therapeutical strategies and managements of DVIE are still debated being the surgical option somewhat challenging. Here we report our single center experience in managements of DVIE. Methods and Materials: Our Endocarditis Registry STEADY, include patients admitted with a diagnosis of IE from 2009 to 2024. Data were retrospectively analyzed focusing on DVIE. All cases were independently evaluated by an infectious disease specialist, a cardiologist and a cardiac surgeon. Variables associated with in-hospital and 1-year mortality were compared between two groups: patients with surgical treatment (STG) and patients with conservative treatment (MTG). Results: Out of 398 patients enrolled in STEADY, 63 (15.8%) had a diagnosis of DVIE. 51 (81%) pts had left side endocarditis, 12 (19%) bilateral endocarditis. 39 (62%) were included in STG group; 24(38%) in MTG. Out of 39 patients of the STG, 18(46%) received urgent surgery. The most frequent pathogen was Streptococcus spp. in both groups (38% in MTG and 31% in STG), followed by Staphylococcus spp. (21% and 23%). Overall 1-year mortality was 19% in STG and 46% on MTG (p=0,047). Conclusions: Patients with DVIE still carry high risk of poor outcomes. To improve the prognosis, patients at higher risk for complications need to be identified and an aggressive therapeutic approach could probably be beneficial.