Are Cases of Endocarditis of Heart Valves Increasing with a Higher Mortality during COVID-19?

Background: During the COVID-19 pandemic, the patient treatment was difficult, the ICUs were crowded, and the patient has been selected in urgent and acute. Furthermore, many patients reject to see the doctor or hospital because they were afraid to be infected with COVID-19. This led to a delayed diagnosis and patient conception. However, endocarditis is an acute dangerous disease with a high risk for thromboembolic events and sepsis and should be treated immediately to prevent and avoid major cardiac events.

Method: In this study, we made a retrospective analysis of patients with endocarditis in 2020 during the first two lockdowns in Austria (15.3–16.11) N = 32 patients and compared it with our data from 2019 to evaluate due to the COVID-19 virus pandemic if the patients had a worse outcome after the operation because of the delay of the diagnosis and the preoperative condition. Our endpoints were 30-day mortality, survival, neurologic deficits, causative pathogens, form of endocarditis and operation.

Results: In 2020, we evaluate 32 patients with a mean age of 62 (± 14) mostly male gender, including prior drug abuse, COVID-19 infection and pacemaker implantation. By analyzing the preoperative condition especially for sepsis, spondylodiscitis, strokes and somnolence the patient arrived in a worse condition with significant more preoperative stays on the ICU. We registered the complications of the endocarditis and the postoperative stay on the ICU, arrhythmias, dialysis, ECMO implantation, thromboembolic events, re-thoracotomies and survival. In total they had more complications intraoperative, a longer stay at the ICU and a higher 30-day and overall mortality. The aortic valve was mostly affected by endocarditis, secondary the mitral valve. In 2020 and 2019, the most common bacteria were Staphylococcus aureus.

Conclusion: The initiation of effective antibiotic therapy was delayed during the pandemic. Also, the patients treated in 2020 had a different microbiological profile compared with 2019. More patients presented 2020 in a worse condition than in 2019 (sepsis, neurological deficits). Subsequently, mortality of patients with endocarditis was higher in 2020.

Publication History

Article published online:
03 February 2022