ANALYSIS OF THE RESULTS OF SURGICAL TREATMENT OF INFECTIVE ENDOCARDITIS IN CHILDREN WITH AN ASSESSMENT OF ITS EFFECTIVENESS

Abstract

The aim of the work: to analyze the results of surgical treatment of infective endocarditis in children and to identify factors that influence its effectiveness.

Materials and Мethods. The study included pediatric patients (n=71) aged 3.0 to 14.8 years (mean age (8.9±3.3) years). In all study participants, infective endocarditis was defined according to the modified Duke criteria, which developed against the background of congenital heart disease or without congenital anomaly of the cardiovascular system. All patients in the sample underwent reconstructive surgeries for infective endocarditis lesions at the Department of Surgical Treatment of Congenital Heart Defects in Newborns and Young Children of the Amosov State Research Institute of Cardiology of the National Academy of Medical Sciences of Ukraine. The material for analysis was data from the primary medical records: medical history, primary medical record, operation protocols, clinical and instrumental examination data. The parents of all study patients gave informed voluntary consent. Statistical analysis of the significance of differences was performed between the study groups at a significance level of 0.05, determined by the χ² criterion with Yates correction. Statistical processing of the study results was performed on a Macbook Pro computer (Apple, USA) using the SPSS Statistics statistical package (IBM, USA) version 26.0.

Results. In this study, hospital mortality was 9.8 %, in patients of the main group it was 8.5 % and in the comparison group – 12.5 %. It was found that patients who were discharged from the hospital for rehabilitation were treated in the hospital for a significantly longer time than patients who died. This trend persisted both in patients of the main group and in patients of the comparison group. The exception was patients from the main group with congenital heart defects of the non-cyanotic type, who were in the hospital for a similar period regardless of the outcome of treatment. It was found that in pediatric patients with infective endocarditis, the following clinical factors significantly influenced hospital mortality, and therefore the effectiveness of surgical treatment: the presence of cyanotic congenital heart defects, embolic neurological complications and the development of heart failure. As a result of multivariate analysis, it was found that the following significantly influenced hospital mortality: nosocomial infection, prolonged preoperative antibiotic therapy, the presence of cyanotic congenital heart defect, embolic neurological complications and development of heart failure.

Conclusions. As a result of studying the results of surgical treatment of infective endocarditis in pediatric patients, factors influencing its effectiveness were identified, in particular, the presence of nosocomial infection, prolonged preoperative antibiotic therapy, the presence of congenital heart defects of the cyanotic type, embolic neurological complications, the development of heart failure or causing hospital mortality.