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<p>Infective endocarditis (IE) is uncommon in children with congenital heart disease (CHD), and limited data exist regarding in-hospital outcomes of those requiring cardiac surgery. We retrospectively reviewed hospitalizations from the pediatric health information system from January 2016 to November 2024. Among 357,031 unique pediatric patients with CHD (≤ 21&#xa0;years), 2108 patients (0.5%) were hospitalized for IE. The index hospitalizations during which cardiac surgery was performed were included. We aimed to characterize in-hospital outcomes among CHD children undergoing cardiac surgery for IE, with sub-analysis of those who required surgery versus medical therapy. The incidence of IE in CHD was 5.6 cases per 1000. Microorganism coding was unavailable in 41.3%; <i>Staphylococcus</i> (24.1%) and <i>Streptococcus</i> (22.3%) were the most common. Stroke occurred in 10.7%. Prosthetic valve endocarditis was present in 9.4%. Overall, 30% of patients required cardiac surgery, most commonly pulmonary valve or conduit procedures (36.6%) and tricuspid valve surgery (16.7%). Two-valve surgery was performed in 13.3%. In-hospital mortality was comparable between surgical and medical patients (10.1% vs 9.6%, <i>p</i> = 0.7). Permanent pacemaker implantation was more common after surgery (6.6% vs 2.2%, <i>p</i> &lt; 0.01). Length of hospital stay and hospitalization costs were higher in the surgical group. On multivariable analysis, older age, heart failure, stroke, and extracorporeal membrane oxygenation (ECMO) were associated with in-hospital mortality. IE in children with CHD remains associated with substantial morbidity and mortality. In-hospital mortality remains high despite cardiac surgery. Older age, heart failure, stroke, and ECMO requirement are independent factors of in-hospital mortality.</p>

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In-hospital Outcomes of Pediatric Cardiac Surgery Admissions for Acute Infective Endocarditis in Congenital Heart Disease

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年9月26日

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  • Mohamed F. Elsisy,
  • Tammy Ruth,
  • Garrett Coyan,
  • Daniel E. Dulek,
  • David Parra

摘要

Infective endocarditis (IE) is uncommon in children with congenital heart disease (CHD), and limited data exist regarding in-hospital outcomes of those requiring cardiac surgery. We retrospectively reviewed hospitalizations from the pediatric health information system from January 2016 to November 2024. Among 357,031 unique pediatric patients with CHD (≤ 21 years), 2108 patients (0.5%) were hospitalized for IE. The index hospitalizations during which cardiac surgery was performed were included. We aimed to characterize in-hospital outcomes among CHD children undergoing cardiac surgery for IE, with sub-analysis of those who required surgery versus medical therapy. The incidence of IE in CHD was 5.6 cases per 1000. Microorganism coding was unavailable in 41.3%; Staphylococcus (24.1%) and Streptococcus (22.3%) were the most common. Stroke occurred in 10.7%. Prosthetic valve endocarditis was present in 9.4%. Overall, 30% of patients required cardiac surgery, most commonly pulmonary valve or conduit procedures (36.6%) and tricuspid valve surgery (16.7%). Two-valve surgery was performed in 13.3%. In-hospital mortality was comparable between surgical and medical patients (10.1% vs 9.6%, p = 0.7). Permanent pacemaker implantation was more common after surgery (6.6% vs 2.2%, p < 0.01). Length of hospital stay and hospitalization costs were higher in the surgical group. On multivariable analysis, older age, heart failure, stroke, and extracorporeal membrane oxygenation (ECMO) were associated with in-hospital mortality. IE in children with CHD remains associated with substantial morbidity and mortality. In-hospital mortality remains high despite cardiac surgery. Older age, heart failure, stroke, and ECMO requirement are independent factors of in-hospital mortality.