Infective Endocarditis and Complications; Surgical Indications and Management: An Integrative Review

TL;DR

Infective endocarditis is a dangerous heart infection with rising incidence and high mortality, requiring both medical and surgical management to address its varied complications.

Contribution

This paper provides an integrative review of IE complications and surgical indications, offering a comprehensive clinical guide for managing this condition.

Findings

Inpatient mortality for IE is 18%, with 30% mortality within six months.

IE can lead to multiorgan dysfunction, septic shock, and disseminated intravascular coagulopathy.

Surgical intervention is necessary in certain cases despite medical treatment being the mainstay.

Abstract

Infective endocarditis (IE) is an infection of the endocardial surface of the heart involving native or prosthetic valves, endocardial structures, or intracardiac devices/leads. Unfortunately, incidence has risen in many settings over recent years. Historically, the incidence has been about 3–10 cases for every 100,000 person-years and was elevated to about 13.8 cases per 100,000 person-years in 2019. Despite advancements in both detection and treatment, mortality remains high, seen with inpatient mortality rates of 18%, along with a 6-month mortality rate of 30%. IE can be a fatal condition if left untreated, in part due to the multiple serious complications that can arise. By anticipating certain complications, clinicians can be better prepared to treat patients with this condition. This article provides an integrative review of the potential complications of IE. These complications vary depending on whether the patient has native or prosthetic valves. There are cardiac, embolic, and immune-complex mediated complications that can occur. Ultimately, IE can lead to multiorgan dysfunction and result in septic shock and disseminated intravascular coagulopathy (DIC). While the mainstay of treatment for IE remains medical, certain cases require surgical intervention. Due to their close relationship, a review of the indications for surgery in the treatment of IE is also presented in this article. By having a general scope of the complications of IE and when to get a surgical consult, clinicians can be better equipped to care for patients with a potentially fatal condition that is becoming increasingly more frequent.

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