Open Access Article April 3, 2025

10 Pages

Impact of the COVID-19 Pandemic on Surgical Outcomes of Native and Prosthetic Valve Endocarditis: A Retrospective Subanalysis

Authors

Jang-Sun Lee1,* , L.Virna Sales2 , Annette Moter3 , Walter Eichinger4

  1. Department of Cardiac Surgery, Munich Hospital Bo-genhausen, Munich, Germany, Technical University Munich, Munich, Germany, Department of Cardiac Surgery, Kerckhoff Clinic, Bad Nauheim, Germany, University Hospital of Giessen, Giessen, Germany
  2. Department of Cardiology, Angiology and medical intensive Care, Cardiovascular center of Hersfeld-Rothenburg, Rothenburg an der Fulda, Germany
  3. Institute of Medical Microbiology and Epidemiology of Infectious Disease, University Hospital of Leipzig, Leipzig, Germany
  4. Department of Cardiac Surgery, Munich Hospital Bogenhausen, Munich, Germany, Technical University Munich, Munich, Germany
  5. * Author to whom correspondence should be addressed.

Journal of Heart Valve Disease Innovation 2025, 30(1), 28-37; https://doi.org/10.36923/jhvd.v30i1.255

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Abstract

Background and aim of the study: During the COVID-19 pandemic in Bavaria, surgical ICU resources were reallocated, and elective procedures were postponed, impacting the management of infective endocarditis (IE). This study evaluated early surgical outcomes in patients with native valve endocarditis (NVE) and prosthetic valve endocarditis (PVE) before and during the pandemic. Methods: We retrospectively analyzed 94 patients (66% male) treated pre-pandemic (August 2018–March 21, 2020) and 84 patients (76% male) treated during the pandemic (March 22, 2020–November 2021). NVE cases comprised 78% pre-pandemic and 68% during the pandemic, while PVE cases increased from 22% to 32%. Preoperative characteristics, surgical urgency, postoperative complications, and in-hospital mortality were assessed. Explanted valves underwent histological, microbiological, and molecular analyses, including fluorescence in situ hybridization (FISH) with 16S rRNA PCR/sequencing. Results: During the pandemic, preoperative NYHA class III-IV increased significantly (NVE: 49% to 74%; PVE: 29% to 70%; all p<0.05). Urgent surgeries became more frequent (NVE: 27% to 49%, p=0.017; PVE: 20% to 52%, p=0.034), and the interval from diagnosis to surgery in PVE patients was prolonged (11 vs. 16 days, p=0.038). More complex procedures, including double-valve surgeries, were required (9.5% vs. 37%, p=0.022). Postoperatively, re-thoracotomy rates increased in NVE cases (OR: 9.106, p<0.001), while odds ratios for stroke, sepsis, and prolonged ICU stay in PVE patients trended higher but lacked statistical significance. Conclusion: The pandemic led to diagnostic delays, worsened preoperative conditions, and increased surgical urgency in IE patients, underscoring the need for resilient healthcare strategies to maintain timely surgical care during future crises.

Article information

Keywords
Infective endocarditisProsthetic valve endocarditisRe-do SurgeryCOVID-19FISH
Section
Articles
Issue
Vol. 30 No. 1 (2025)
Submitted
February 9, 2025
Accepted
March 26, 2025
Published
April 3, 2025
Corresponding author
Jang-Sun Lee
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