Surgical Treatment of Active Endocarditis Pre- and Post-COVID-19 Pandemic Onset

Abstract

Background: Despite advanced diagnosis and treatment, infective endocarditis (IE) is a potentially life-threatening condition. The impact of COVID-19 on the diagnosis and outcome of the surgical treatment of IE is uncertain. The aim of this study was to analyze the incidence, characteristics, and outcomes of surgically treated IE before and after the COVID-19 pandemic. Methods: This study retrospectively analyzed the data of 535 patients who underwent valve surgical procedures for IE between January 2010 and December 2022 in a single cardiac surgery center. Patients were divided into two groups depending on the date of their operation: before (n = 393) and after (n = 142) COVID-19 onset. In order to balance the groups, inverse probability of treatment weighting (IPTW) calculated from the propensity score (PS) was applied. Weighted univariate logistic regressions were reported for outcomes; weights were derived from IPTW. Interrupted time series analysis (ITSA) according to Linden’s method was used to evaluate the changes in the manifestation of IE after 11 March 2020. Results: Patients from the post-COVID-19 cohort (after 11 March 2020) had a greater number of comorbidities such as diabetes (29.6% vs. 16.3% p = 0.001), hypertension (71.1% vs. 59.5% p = 0.015), and preoperative kidney injury requiring dialysis (9.2% vs. 2.5% p = 0.002), but the median additive and logistic EuroSCORE were not statistically different. In the post-COVID-19 group, we observed a greater prevalence of Staphylococcus aureus-related endocarditis (24.5% vs. 15.4% p = 0.026), a consequent reduction in Staphylococcus non aureus-related endocarditis (12.2% vs. 20.1% p = 0.048), and a decrease in aortic valve replacements (43.0% vs. 53.9%), while the number of mitral valve replacements and repair was greater (21.1% vs. 15.0% and 6.3% vs. 4.3%, respectively). No differences were found in the two groups concerning early death, death, or relapse at 1 year after surgery. Data obtained by multivariable analysis identified preoperative renal dysfunction requiring dialysis as the only common risk factor for early mortality via stratifying by time periods in analysis. Conclusions: The incidence of surgically treated IE significantly increases after the COVID-19 pandemic with a higher incidence of mitral valve involvement with respect to the aortic valve. Although a delay in surgical timing occurred during the COVID-19 pandemic, data in terms of mortality and outcomes were largely unaffected.

Impact of the SARS-CoV-2 Pandemic on the Management and Prognosis of Infective Endocarditis

“…Liu et al compared patients with surgical IE between 2020 and 2019; delaying surgery and performing surgery did not differ between the two periods [ 20 ]. Finally, in the three studies cited above and in contrast to our results, patients appeared to have had a significantly higher preoperative risk according to their EuroSCORE II [ 20 , 24 , 25 ].…”

“…Nevertheless, in their study, there was a higher rate of IE surgery during the SARS-CoV-2 pandemic. These results are consistent with the study of Mikus et al, where they found a significant increase in the number of IE patients referred to their centre for surgery [25]. Our results were consistent with these data and there was no significant difference between the two groups in terms of the performance of either cardiac surgery or the removal of an intra-cardiac device.…”

“…Surgical management of IE did not seem to have been impacted by the pandemic. SARS-CoV-2 infections in IE patients could have led to serious consequences for patients, delaying surgery due to risk of contagion or logistic organization [ 25 , 26 ]. The study of Mikus et al noticed an increase from 16 to 19 days in the median time from endocarditis diagnosis to surgery [ 25 ].…”

“…SARS-CoV-2 infections in IE patients could have led to serious consequences for patients, delaying surgery due to risk of contagion or logistic organization [ 25 , 26 ]. The study of Mikus et al noticed an increase from 16 to 19 days in the median time from endocarditis diagnosis to surgery [ 25 ]. Furthermore, in our study, there were significantly more cerebral haemorrhages in Group 2.…”