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Surgical outcome of infective endocarditis at Tygerberg Hospital from 2010-2019 : a retrospective review
Thesis (MMed)--Stellenbosch University, 2023.
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| Format: | Thesis |
| Language: | en_ZA |
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Stellenbosch : Stellenbosch University
2023
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| _version_ | 1867613901164642304 |
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| access_status_str | Open Access |
| author | Nel, Riaan Frederik |
| author2 | Janson, Jacques Teran |
| author_browse | Janson, Jacques Teran Nel, Riaan Frederik |
| author_facet | Janson, Jacques Teran Nel, Riaan Frederik |
| author_sort | Nel, Riaan Frederik |
| collection | Thesis |
| dc_rights_str_mv | Stellenbosch University |
| description | Thesis (MMed)--Stellenbosch University, 2023. |
| format | Thesis |
| id | oai:scholar.sun.ac.za:10019.1/128829 |
| institution | Stellenbosch University (South Africa) |
| language | en_ZA |
| last_indexed | 2026-06-10T12:43:30.254Z |
| license_str | Other — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from SUNScholar — Stellenbosch University Repository |
| publishDate | 2023 |
| publishDateRange | 2023 |
| publishDateSort | 2023 |
| publisher | Stellenbosch : Stellenbosch University |
| publisherStr | Stellenbosch : Stellenbosch University |
| record_format | dspace |
| source_str | SUNScholar — Stellenbosch University Repository |
| spelling | oai:scholar.sun.ac.za:10019.1/128829 Surgical outcome of infective endocarditis at Tygerberg Hospital from 2010-2019 : a retrospective review Nel, Riaan Frederik Janson, Jacques Teran Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Surgery. Infective endocarditis -- Surgery Heart -- Surgery Heart valves -- Surgery Heart -- Diseases UCTD Thesis (MMed)--Stellenbosch University, 2023. ENGLISH SUMMARY: Background: There is a paucity of data on the outcome of left sided cardiac valve surgery for infective endocarditis in South Africa. It is hypothesised that outcomes may be poorer compared to international standards due to differences in disease burden, timing to surgery, organism prevalence, and co-morbidities. Method: This is a retrospective study of 160 patients with left heart valve endocarditis who underwent cardiac surgery from January 2010 until December 2019. Demographic, operative, and admission-related parameters were assessed to determine their association with all-cause mortality during the early postoperative (<30 days) and late postoperative (>30 days) periods. The study aimed to measure early and long-term mortality as well as identify risk factors for morbidity and mortality. Results: Early post operative mortality (<30 days) was 8.8% and late post-operative mortality (>30 days) was 13.1%. Late survival showed 77.5% of the patients were alive with a mean follow up period of 41 months. Increased age (p=0.04), critical illness (p<0.001), and higher urgency of intervention (p<0.001) were associated with higher early post-operative mortality. EuroScore II was a predictor of early mortality (p<0.001), but less accurate after 30 days. Peri-operative organ failure, including cardiac (p=0.025), renal (p=0.016), and respiratory failure (p<0.001), contributed significantly to both early and late mortality. Pre-operative antibiotics for fewer days (p=0.024), ongoing sepsis (p=0.022), and para-valvular extension (p=0.046) were associated with higher early mortality. Culture negative endocarditis was high at 52.5%. Both left and right ventricular function were significantly impaired early post-operatively but recovered well with long-term follow-up. Conclusion: Infective endocarditis is a common indication for cardiac valve surgery in South Africa, with a high rate of culture-negative cases making antibiotic stewardship challenging. Goal-directed medical management and clinical optimization prior to surgery were crucial to achieving better outcomes. Salvage procedures and critical illness with organ failure prior to surgery were associated with poorer outcomes. Despite unique challenges, cardiac surgery for infective endocarditis at Tygerberg Hospital compares favourably to international standards. AFRIKAANSE OPSOMMING: Agtergrond: Daar is 'n gebrek aan data oor die uitkoms van linker hartklep chirurgie vir infektiewe endokarditis in Suid-Afrika. Daar word vermoed dat die uitkomste swakker kan wees in vergelyking met internasionale standaarde as gevolg van verskille in siekte las, tydsberekening vir chirurgie, organisme voorkoms en mediese toestande. Metode: Dit is 'n retrospektiewe studie van 160 pasiente met linker hartklep endokarditis wat vanaf Januarie 2010 tot Desember 2019 hartchirurgie ondergaan het. Demografiese, operatiewe en opname verwante parameters is geevalueer om hul assosiasie met alle-oorsaak mortaliteit tydens die vroee postoperatiewe (<30 dae) en laat postoperatiewe (>30 dae) periodes te bepaal. Die studie het ten doel om vroee en langtermyn mortaliteit te meet en risikofaktore vir morbiditeit en mortaliteit te identifiseer. Resultate: Vroee postoperatiewe mortaliteit (<30 dae) was 8.8% en laat postoperatiewe mortaliteit (>30 dae) was 13.1%. Laat oorlewing toon dat 77.5% van die pasiente nog lewendig was met 'n gemiddelde opvolgperiode van 41 maande. Verhoogde ouderdom (p=0.04), kritieke siekte (p<0.001) en hoer dringendheid van ingryping (p<0.001) was geassosieer met hoer vroee postoperatiewe mortaliteit. EuroScore II was 'n voorspeller van vroee mortaliteit (p<0.001), maar minder akkuraat na 30 dae. Peri-operatiewe orgaan versaking, insluitend hartversaking (p=0.025), nierversaking (p=0.016) en respiratoriese versaking (p<0.001), het beduidend bygedra tot beide vroee en laat mortaliteit. Pre-operatiewe antibiotika vir minder dae (p=0.024), aanhoudende sepsis (p=0.022) en abses formasie Masters 2023-09-27T13:30:30Z 2024-01-08T12:38:58Z 2023-09-27T13:30:30Z 2024-01-08T12:38:58Z 2023-12 Thesis https://scholar.sun.ac.za/handle/10019.1/128829 en_ZA Stellenbosch University 34 pages : illustrations, includes annexures application/pdf Stellenbosch : Stellenbosch University |
| spellingShingle | Infective endocarditis -- Surgery Heart -- Surgery Heart valves -- Surgery Heart -- Diseases UCTD Nel, Riaan Frederik Surgical outcome of infective endocarditis at Tygerberg Hospital from 2010-2019 : a retrospective review |
| title | Surgical outcome of infective endocarditis at Tygerberg Hospital from 2010-2019 : a retrospective review |
| title_full | Surgical outcome of infective endocarditis at Tygerberg Hospital from 2010-2019 : a retrospective review |
| title_fullStr | Surgical outcome of infective endocarditis at Tygerberg Hospital from 2010-2019 : a retrospective review |
| title_full_unstemmed | Surgical outcome of infective endocarditis at Tygerberg Hospital from 2010-2019 : a retrospective review |
| title_short | Surgical outcome of infective endocarditis at Tygerberg Hospital from 2010-2019 : a retrospective review |
| title_sort | surgical outcome of infective endocarditis at tygerberg hospital from 2010 2019 a retrospective review |
| topic | Infective endocarditis -- Surgery Heart -- Surgery Heart valves -- Surgery Heart -- Diseases UCTD |
| url | https://scholar.sun.ac.za/handle/10019.1/128829 |
| work_keys_str_mv | AT nelriaanfrederik surgicaloutcomeofinfectiveendocarditisattygerberghospitalfrom20102019aretrospectivereview |