Congenital: Endocarditis| Volume 165, ISSUE 1, P275-284, January 2023

Surgical outcomes of infective endocarditis in pediatrics: Moving the needle to a contemporary, multidisciplinary approach



      Infective endocarditis (IE) is an uncommon disease in children that, when present, is accompanied by significant morbidity and mortality. The presence of congenital heart disease often complicates management. The aim of the present study is to describe the characteristics and outcomes of children undergoing surgery for IE.


      A retrospective chart review from 2004 to 2020 was conducted to identify consecutive patients younger than age 20 years with IE undergoing surgery.


      A total of 94 patients with IE were identified, of whom 47 underwent surgery at a median age of 16.7 years. Thirty-one patients (65.95%) had congenital heart disease. Vegetation and embolic phenomena occurred in 41 and 29 patients (87.23% and 61.7%), respectively, with the brain as most common location (57.1%). Native valve involvement had a greater tendency to embolize (P < .001). Staphylococcus spp was the most common organism (49%). The mitral valve was the most affected (31.9%). Seven (14.9%) patients had multivalvar involvement and valve replacement was the most common procedure performed (37 patients; 78.7%). There were 3 operative deaths (6.4%). Median length of hospital stay was 21 days. Risk factors for prolonged hospital stay were time to surgery in days (P < .001) and native valvar involvement (P = .05). Five patients (10.6%) had postoperative recurrent IE. Survival at 1 and 5 years was 93.6% and 89.4%, respectively.


      Children with IE can undergo surgery with acceptable results. The morbidity, but not mortality, is driven by embolic complications. Staphylococcus spp and native valve involvement are significant risk factors.

      Video Abstract

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      Graphical abstract

      Key Words

      Abbreviations and Acronyms:

      CHD (congenital heart disease), EMR (electronic medical records), IE (infective endocarditis), LOS (hospital length of stay), PIE team (pediatric infective endocarditis team), RVOT (right ventricular outflow tract)
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      Linked Article

      • Commentary: Multidisciplinary management of pediatric endocarditis: No PIE in the sky
        The Journal of Thoracic and Cardiovascular SurgeryVol. 165Issue 1
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          Infective endocarditis (IE) in children is relatively rare, and, as such, there are only a few single-center reports on its surgical management. Current recommendations for the management of children with IE are largely derived from adult guidelines.1 However, the appropriateness of extrapolating adult guidelines to children is unclear; hence, there is a need for further data on outcomes of children undergoing surgery for IE. Furthermore, the burden of endocarditis in children is likely to increase due to greater use of endovascular prostheses and indwelling lines, as well as the growing population with repaired congenital heart disease.
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