PERIOPERATIVE CHARACTERISTICS AND EARLY OUTCOMES OF SURGERY FOR INFECTIVE ENDOCARDITIS: A RETROSPECTIVE COHORT

Background: Surgery for active infective endocarditis combines valvular destruction and extracardiac organ injury. Anesthesia and critical-care data from North Africa are scarce. We characterized perioperative management and early outcomes at a Moroccan tertiary center.
Methods: Retrospective single-center cohort, January 2023 to September 2025. Consecutive adults admitted to ICU after surgery for active infective endocarditis were included. Primary outcome was in-hospital mortality within 30 days after surgery; analyses were descriptive with Wilson 95% confidence intervals.
Results: Of 273 valvular surgical admissions, 20 underwent surgery for infective endocarditis (7.3%). Mean age was 44 years; 80% were men, 45% had rheumatic and 30% congenital heart disease, and Euro SCORE II was >5% in 40%. Blood cultures were positive in 55%. Vegetations were surgically confirmed in all patients and detected by preoperative transthoracic echocardiography in 19/20 (95%). Cerebral ischemic lesions were present preoperatively in 35%. Eighty per cent underwent urgent or emergency surgery after a mean of 21 days of antimicrobial therapy. Mean cardiopulmonary bypass and cross-clamp times were 86 ± 21 and 63 ± 12 minutes. All patients received noradrenaline plus dobutamine at bypass separation; two required rescue adrenaline. Anuric acute kidney injury occurred in 15%, new postoperative ischemic stroke in 10%, and in-hospital mortality within 30 days was 20% (4/20; 95% CI 8.1–41.6).
Conclusions: Surgically treated infective endocarditis involved young patients with substantial embolic burden and intensive hemodynamic support. The antimicrobial-to-surgery interval raises a hypothesis regarding delays along the diagnostic and referral pathway but does not identify their location.