Factors associated with long-term outcomes in adult congenital heart disease patients with infective endocarditis: A 16-year tertiary single-centre experience.

OBJECTIVES: Studies concerning factors associated with long-term outcomes in adult congenital heart disease patients after infective endocarditis are scarce, while infective endocarditis-related mortality in these patients remains a burden. We evaluated the factors associated with long-term survival in adult congenital heart disease patients admitted for infective endocarditis.

METHODS: We performed a retrospective single-centre study of all adult congenital heart disease patients admitted for infective endocarditis to a tertiary cardiothoracic centre between 1999 and 2015. Underlying adult congenital heart disease, detailed echocardiographic and clinical data, surgical treatment and long-term follow-up were analysed.

RESULTS: We identified 151 adult congenital heart disease patients admitted due to 176 episodes infective endocarditis with 30-day, 6-month, 1-, 5- and 10-year survival of 95.4%, 92.7%, 92.7%, 84.7% and 75.6%, respectively. In a multivariable analysis, adjusted estimated probability of death was consistently higher after an infective endocarditis episode among patients with complex as compared to simple/moderate adult congenital heart disease: 10.6% vs. 2.4% at 30 days, 15.0% vs. 3.4% at 6 months and 1 year, 30.4% vs. 7.8% at 5 years, and 44.9% vs. 13.1% at 10 years. Risk of death was higher among patients with prosthetic valve in comparison with those without (RR 1.73-1.92). Surgical treatment was required in 76 (43.2%) episodes with 30-day mortality of 3.9%. Risk of death appeared to be lower than in the conservatively treated subgroup (RR 0.71-0.78).

CONCLUSIONS: We demonstrated satisfactory long-term survival in adult congenital heart disease patients who were treated for infective endocarditis in a tertiary cardiothoracic centre. Early mortality tended to be lower in the surgically treated subgroup. Factors negatively associated with long-term survival were complex adult congenital heart disease and presence of prosthetic valve.