Abstract
Background
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.
Methods
A retrospective chart review from 2004 to 2020 was conducted to identify consecutive
patients younger than age 20 years with IE undergoing surgery.
Results
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.
Conclusions
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
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)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: April 08, 2022
Accepted:
March 21,
2022
Received in revised form:
March 9,
2022
Received:
September 28,
2021
Footnotes
Read at the 47th Annual Meeting of the Western Thoracic Surgical Association, Phoenix, Arizona, September 29-October 2, 2021.
Identification
Copyright
© 2022 by The American Association for Thoracic Surgery
ScienceDirect
Access this article on ScienceDirectLinked Article
- Commentary: Multidisciplinary management of pediatric endocarditis: No PIE in the skyThe Journal of Thoracic and Cardiovascular SurgeryVol. 165Issue 1
- PreviewInfective 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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