Long term outcome and the validity of EuroSCORE II in native-valve surgery for active endocarditis in a South African cohort

Infective endocarditis was initially described in the early 16th century and only methodically reviewed after the 19th century when Osler gave the drive to the Royal College of Physicians in 1885 through his contribution. The last 25 years has not shown much change in the mortality from infective endocarditis (IE) despite diagnostic and therapeutic advances. The current in-hospital mortality rate for patients with IE is 15% to 20%, with 1-year mortality approaching 40%. The morbidity associated with infective endocarditis includes valvular incompetence, embolization, cerebrovascular accidents and congestive heart failure and this has influenced the surgical options to a great extent. The EuroSCORE II is the current model available for predicting the early mortality after cardiac surgery. HYPOTHESIS: Infective endocarditis has a high risk for mortality due to certain risk factors and the currently available EuroSCORE II model may not predict early mortality accurately and may not be suitable for our patient population. OBJECTIVES: To evaluate the major risk factors for adverse short and long term outcomes in patients with active native valve infective endocarditis needing cardiac surgery, and to validate the EuroSCORE II in our cohort of patients. PATIENTS AND METHODS: A retrospective review will be undertaken on patients with infective endocarditis requiring cardiac surgery from 2000-2012 at the Christian Barnard Division of Cardiothoracic surgery (Groote Schuur Hospital, UCT Private Academic Hospital) and follow-up with respect to mortality, re-operation and major adverse cardiac events, as well as an evaluation of the validity of the EuroSCORE II. DATA COLLECTION AND ANALYSIS: The standardized data extraction form in the appendix will be used for extracting data from various databases and telephonic interviews. Data will be analyzed using STATA to determine the most significant predictors of adverse outcome and conducting Kaplan Meier actuarial analysis for early and late survival and freedom from adverse events. The EuroSCORE II will be evaluated and validated to our cohort of patients