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.