Survival
In the surgical group two patients died before discharge for an overall in-hospital mortality of 10%; causes of death were uncontrollable bleeding and multi-organ failure due to sepsis. The overall survival at 1-year and 7-year follow up was 90% and 83%, respectively.
Three patients who underwent medical management were not discharged from hospital (30% mortality). One of them experienced a sudden death on day 17, one patient had a new cerebral embolism with brain haemorrhage and died 15 days after the admission, in one case there was a sudden deterioration with development of multiple organ failure due to combined sepsis and heart failure and death on day 11 since the admission.
The three patients who presented with a periannular abscess and underwent medical treatment died in the first 4 months since diagnosis. Furthermore, two patients in the medical group, who initially presented without local complications, developed a periannular abscess and rupture of the aorto-ventricular junction. In one case, there was a rapid expansion of the infective process despite an ongoing targeted antibiotic therapy, the patient ultimately died at 40 days since the diagnosis (Videos 1 and 2). The other patient had a relapse of infective endocarditis after 5 years and developed aorto-ventricular discontinuity with systolic graft collapse and severe mitral regurgitation (Video 3). Table 4 details about early and late course of patients who had lone medical treatment.
For patients who did not undergo a cardiac reoperation, the overall survival at 1-year and 7-year was 50% and 33%, respectively.