Incorporation of structural heart intervention in the management plan of infective endocarditis patients

Résumé fourni par la source

Abstract Background Infective endocarditis (IE) is a disease of increasing incidence and high clinical impact. After proper control of infection, IE can leave hemodynamically significant residual structural lesions requiring intervention. While surgical correction is indicated in large number of these patients, it may be prohibitive for its high risk. Aim and Objectives This study aims to assess the safety and mid-term outcomes of an elective, planned percutaneous structural intervention after control of infection in patients with endocarditis-related lesions, who are not indicated for urgent or emergent surgery. Methods A prospective single-centre cohort study was conducted at Cairo University Hospitals, between November 2023–February 2025 including patients with possible/definite IE. Patients were recruited if they had an IE-related lesion indicated for intervention, judged feasible for transcatheter repair, and had high surgical risk, without urgent/emergent surgical indications. The strategy included guideline-directed antibiotics, monthly clinical and echocardiographic follow-up for 6 months, and pre-procedural 18F-FDG PET/CT to exclude active infection. At the end of follow up phase, transcatheter intervention was performed. Results Among 122 admitted with IE, 20 patients were ultimately enrolled in the planned intervention strategy. Among them, 2 patients showed improvement within the 6-months follow up and therefore required no intervention, whereas 3 patients deteriorated and required urgent surgical management. The remaining 15 patients (75%) completed the scheduled follow-up and proceeded to the structural intervention for IE-related lesions. Technical and procedural success was achieved in all treated patients. No deaths or infective relapse were recorded during the 6-month post-intervention follow-up. Conclusions Planned percutaneous structural intervention may be a safe alternative therapeutic option for patients with endocarditis-related lesions who require intervention after control of infection but are not candidates for urgent or emergent surgery.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.