Surgery changes prognosis in infective endocarditis: The importance of post-surgical clinical evolution

Left-sided infective endocarditis (LSIE) bears a grim prognosis and surgery is needed in more than half of the patients to improve survival. Our hypothesis has been that clinical complications developing after surgery impact prognosis. Among 1075 consecutive episodes of LSIE, 654 (60.7%) underwent cardiac surgery. Of them, 41 patients (6.3%) died the same day of surgery, 112 (17.2%) died after the first day of surgery during hospital stay and 500 (76.5%) were successfully discharged. We compared the last two groups and performed a multivariable analysis of in-hospital mortality. Age (OR 1.02, 95% CI 1.01–1.04), periannular complications (OR 1.9, 95% CI 1.2–3.2) renal failure after surgery (OR 2.4, 95% CI 1.3–4.4) but not before surgery, and septic shock after surgery (OR 9.6, 95% CI 5.4–17.1) but not before surgery are predictive of in-hospital death among LSIE patients who underwent cardiac surgery. A thorough clinical assessment with prognostic purposes in infective endocarditis after surgery is mandatory. In-hospital mortality of patients with infective endocarditis who undergo surgery depends mainly on the clinical evolution after surgery. •Timing of clinical complications impacts prognosis in LSIE.•Renal failure and septic shock after surgery are the strongest predictors.•In hospital mortality of LSIE depends mainly on clinical evolution after surgery.•Prognostic reassessment after surgery for LSIE is mandatory.