Pediatr Cardiol. 2025 Sep 26. doi: 10.1007/s00246-025-04037-7. Online ahead of print.
ABSTRACT
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.
PMID:41006584 | DOI:10.1007/s00246-025-04037-7
