Early Surgery Determines Prognosis in Patients with IE: Outcome of Patients Managed by an Endocarditis Team - a Prospective Cohort Study

Background: Infective endocarditis(IE) in South Africa is associated with significant morbidity and mortality, despite occurring in younger patients with fewer co-morbidities. Possible contributors include the high rates of blood culture negative endocarditis, high rates of mechanical valve replacement and the lack of inter-disciplinary coordination during management. Methods: The Tygerberg Endocarditis Cohort study prospectively enrolled patients with IE between November 2019 and April 2021.All patients were managed by an Endocarditis Team with a set protocol for organism detection and a strategy of early surgery limiting the use of prosthetic material. Results: Seventy-two(72) consecutive patients with IE were included, with a causative organism identified in 86.1% of patients. The majority of patients had a guideline indication for surgery(80.6%). The in-hospital mortality rate was 18%, with a 6-month mortality rate of 23.3%. Surgery was performed in 42 patients(58.3%), with prosthetic valve replacement in 76.2%, conventional repair surgery in 19.1% and mitral valve reconstruction in 4.8% of patients. Patients who underwent surgery had a significantly lower in-hospital(4.8%vs.56.3;p<0.01) and 6-month(5.3%vs.75%;p<0.01) mortality rate as compared with patients with an indication for surgery who did not undergo surgery. Conclusion: We have observed a reduction in the 6-month mortality in patients with IE following the establishment of an Endocarditis Team, adhering to a set protocol for organism detection and favouring early repair or reconstruction surgery. Patients who underwent surgery had a significantly lower mortality rate than patients with an indication for surgery who did not undergo surgery. Preventable residual mortality was driven by surgical delay. Funding: None Declaration of Interest: None. Ethical Approval: This study was approved by the Health Research Ethics Committee (HREC) of Stellenbosch University (Project number S19/08/162) and performed in accordance with the Declaration of Helsinki (2013 version). All patients signed written informed consent.