Management and Outcome of Infective endocarditis in adults with congenital heart disease

Background Causes, epidemiology and microbiology of infective endocarditis (IE) have evolved in recent decades. Although novel tools for diagnosis and therapeutic strategies have emerged, mortality and morbidity remained high. These trends may particularly concern the growing population of adults with congenital heart disease (ACHD) who have an increased risk for IE. Purpose We aimed to describe causes, management and outcome of IE in ACHD, and to analyze the risk factors for in-hospital death. Methods From 1997 to 2017, 628 consecutive episodes of IE in adults were recorded in our center. Among them, 118 (18.7%) concerned 117 ACHD (mean age, 40 ± 17.7 years, 80.5% male). Endocarditis was classified according to the modified Duke criteria. Results Overall, 50.8% of patients had a simple CHD, 12,7% a moderate, and 36,4% a complex. A total of 37,3% were right sided IE (97,3% pulmonary site and 2,3% tricuspid valve). It was at least the second episode of IE for 18 patients (15.3%) and a predisposing event could be identified in only 30.3% cases. Oral streptococci and Staphylococcus aureus were the most frequently microorganisms isolated (31.1% and 25,4%, respectively). Surgical intervention was performed in 76 episodes (64,5%). In-hospital mortality was 10.2% and was directly related to IE in 9/12 cases. On univariate analysis, risk factors for death were complexity of CHD (OR = 7.2, 95% CI[1.1–48.2] and OR = 5.3 95% CI[1.0–27.1] for moderate and complex CHD respectively, P  ≤ 0.04), numbers of sternotomies ≥ 2 (OR = 5.1, 95% CI[1.2–21.2], P  = 0.02), and leukocytes number (OR = 1.1, 95% CI[1.0–1.2], P Conclusions Mortality associated with IE in ACHD patients is lower than reported in acquired heart disease. Multidisciplinary approach by IE team and GUCH specialists may have improved management and outcome in this setting. However, risk for death remains high in complex lesions.