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Review
. 2019 Nov;11(11):4875-4885.
doi: 10.21037/jtd.2019.10.45.

Infective endocarditis: trends, surgical outcomes, and controversies

Mahbub Jamil  1 , Ibrahim Sultan  1 , Thomas G Gleason  1 , Forozan Navid  1 , Michael A Fallert  2 , Matthew S Suffoletto  2 , Arman Kilic  1
Affiliations
Review

Infective endocarditis: trends, surgical outcomes, and controversies

Mahbub Jamil et al. J Thorac Dis. 2019 Nov.

Abstract

The number of hospitalizations and surgical cases of infective endocarditis (IE) are increasing. The aim of this study was to review these trends, surgical outcomes, and controversies related to IE. A search of MEDLINE of studies published between 1960 and 2018 was conducted. Search terms included "infective endocarditis", "history of", "trend", "epidemiology", "outcome", "medical management", "surgery", "indication", and "re-operative surgery", or any combination thereof. The United States has the highest incidence of IE in the world at 15 per 100,000 people, with increases in incidence due to the aging population as well as increasing rates of intravenous drug use (IVDU). National guidelines support early surgical intervention in specific clinical settings in both left and right-sided IE. However, only 11% of the evidence used in formulating guidelines for surgical therapy in IE are based on level A evidence. Ongoing controversies include whether to perform surgery in the setting of continued or recurrent IVDU in a patient with a prior valve operation, timing of surgery after acute stroke due to IE, and general indications for surgery for tricuspid valve IE. IE has a surging incidence and increasing burden on the healthcare system in the United States. Multiple controversies exist, and formulating level A evidence and multidisciplinary collaboration will be essential components to effectively treating this complex patient population.

Keywords: Infective endocarditis (IE); controversies; outcomes; surgery; trends.

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Conflict of interest statement

Conflicts of Interests: Thomas Gleason: Medical Advisory Board, Abbott (Chicago, IL, USA). Arman Kilic: Medical Advisory Board, Medtronic, Inc. (Minneapolis, MN, USA). University of Pittsburgh Medical Center Heart and Vascular Institute receives research support from Medtronic, Abbott, and Boston Scientific (Marlborough, MA, USA). The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Increasing burden of infective endocarditis in the United States. (A) Trend in the incidence of infective endocarditis hospitalization in the U.S. (per 100,000 population), and (B) valve replacement rates for infective endocarditis (per 1,000 IE cases) in the U.S. from 2000 to 2011 (3).
Figure 2
Figure 2
Trends in intravenous drug users among surgical patients with infective endocarditis at a tertiary hospital in the U.S. (6).
See this image and copyright information in PMC

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