Despite improvements in treatment, infectious endocarditis is a potentially fatal condition that affects intracardiac devices and native or prosthetic valves. Its morbidity and fatality rates remain high. Heart surgery is necessary for up to half of patients, although perioperative risk factors are still not well understood.
IE is a systemic inflammatory disease that is often linked to normocytic anemia, but the information that is currently available is constrained by small studies, variable classifications, and a focus on individuals receiving medicinal treatment. Although both anemia and transfusion are associated with unfavorable results in cardiac surgery and anemia predicts bad outcomes in non-surgical IE, it is unclear how these factors relate to surgically treated IE.
Thus, determining the prevalence and severity of preoperative anemia, describing transfusion and coagulation therapy, and assessing the relationships between anemia and red blood cell (RBC) transfusion and mortality, including sex-based variations, were the objectives of this study.
The Netherlands Heart Registration provided data for this retrospective multicenter cohort analysis, which included all adult patients who had valve surgery for active IE between January 1, 2016, and December 31, 2023. WHO standards were used to determine anemia. The relationships between anemia severity, RBC transfusion, and 30-day and 1-year mortality were assessed using Kaplan-Meier and Cox proportional hazards models. Age, sex, previous valve surgery, renal dysfunction, surgical urgency, cardiopulmonary bypass and aortic cross-clamp periods, surgical re-exploration, preoperative critical illness, and year of operation were all taken into account in multivariable analyses.
84.9% of the 2480 patients had preoperative anemia (2.8% severe, 50.7% moderate). 78.7% of patients received an RBC transfusion. The 30-day and 1-year mortality rates were 10.6% and 16.6%, respectively. In univariable analysis, moderate and severe anemia were linked to increased mortality, but not in multivariable analysis.
At both time periods, RBC transfusion continued to be independently linked to death (adjusted HR for mortality at 30 days 3.58, 95% CI 2.07 to 6.19). Transfusion rates and death were greater in female patients. Overall, this study emphasizes how important blood transfusions and anemia are to the prognosis of IE patients after heart valve surgery.
Source:
Breel, J. S., Bozic, C., Alberts, T., Strypet, M., Mansvelder, F. J., Schober, P., Kamp, O., Boekholdt, S. M., Klautz, R. J. M., Müller, M. C. A., van der Vaart, T. W., Tanis, W., van der Stoel, M., Hollmann, M. W., Eberl, S., & Hermanns, H. (2025). Anaemia and blood transfusion in cardiac surgery with infective endocarditis. Heart (British Cardiac Society), heartjnl-2025-326424. https://doi.org/10.1136/heartjnl-2025-326424
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