Outcomes of surgical intervention for infective endocarditis in pediatric patients

Purpose Infective endocarditis (IE) which is an uncommon disease in pediatric patients can cause significant morbidity and mortality. IE is treated with antibiotics as well as surgical intervention. The aim of this study is was to identify the demographic of IE in children and outcomes of surgical therapy

Methods Between 1990 and 2017, 39 patients (24 males) under 18 years underwent surgical intervention for infective endocarditis.

Results Median age was 8.2 years (0.1 to 17.9). The organisms were detected in 29 patients’ blood culture, Streptococcus Viridans (n=12) and Staphylococcus aureus (n=10) were predominant organisms. Vegetation were revealed in echocardiography in 34 patients, but operative findings was confirmed vegetation in 30 patients. Embolic events were occurred in 16 patients (Right side embolism in 10). Median duration of antibiotics was 6 weeks (range, 0 to 14.9). Thirty patients (76.9%) had a congenital heart disease (CHD), 14 patients had a previous cardiac operation for correction of CHD.

Results Surgical intervention included vegetation in 32, valve repair in 8, valve replacement in 11 and conduit replacement in 4. In patients who underwent valve repair or replacement, reoperation for valve was performed in 4 patients (recurred IE in 1). There were three early death due to uncontrolled sepsis after neonatal correction of CHD. There were two late death after operation. Freedom from death and 5 years were 92.0% ± 4.5%.

Conclusion The outcome of surgical therapy for IE in pediatric population is acceptable. Surgical outcome of infective endocarditis related to uncontrolled sepsis following neonatal repair of CHD is suboptimal