CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 2, May/June 2023 AFRICA 85 perform surgery was the death of patients before surgery (30%), followed by patient refusal (18.89%). Thirty-one patients died in hospital (34.44%) and the most common cause was combined cardiogenic and septic shock. The mean duration of survival from admission to death was 19.19 ± 10 days (range 5–53 days) (Table 6). Fifty-nine patients were eligible for follow up and 11 were lost to follow up. Five patients died (8.47%), seven presented with heart failure (11.86%) and four underwent a re-do surgery (6.78%), three of them on top of a re-infection (5.08%) and one on top of mechanical valve thrombosis (Table 7; Fig. 3). Discussion In our study, the mean age of the included patients was 36.72 ± 11.89 years and 76.67% were males. In the multi-centre study by Habib et al. in 2019, which included 3 116 patients, the mean age was 59.25 ± 18.03 years with 68.9% males.18 In another study by Blanchard et al. in 2020, which included 105 patients, the mean age reported was 55 ± 17 years with 65% males.19 In 2020, El Kadi et al. published a study conducted on 139 patients and the mean age was 63.9 years with 68.3% males.20 In 2021, Acibuca et al. published a similar study on 139 patients and the mean age was 55 ± 16 years with 59.7% males.21 Also in 2021, Babeș et al. completed a study on 92 patients with a mean age of 63.80 ± 13.45 years with 53.3% males.22 Lastly in 2021, Zahn et al. published a study conducted on 171 patients over four years and the mean age was 66.5 ± 13 years with 74.9% males.23 From these data we see that the mean age of the population in our study was younger than in the other studies. This may have been due to the higher prevalence of rheumatic heart disease and the increasing numbers of IV drug abusers in our country. Table 4. Echocardiographic data Echocardiographic data Mean ± SD, median (range) or n (%) Transthoracic baseline echocardiographic data Left ventricular end-diastolic dimension (mm) 53.78 ± 3.33 Left ventricular end-systolic dimension (mm) 33.6 ± 4.91 Left ventricular end-diastolic volume (ml) 132.9 ± 17.21 Left ventricular end-systolic volume (ml) 56.23 ± 16.44 Left ventricular ejection fraction (%) 58.19 ± 8.24 Maximal vegetation size (mm) 16.58 ± 9.17 15 (5–35) Abscess 17 (18.89) Right ventricular dysfunction 19 (21.11) Pericardial effusion 17 (18.89) Sites of vegetations Native aortic valve 26 (28.89) Native mitral valve 32 (35.56) Native tricuspid valve 25 (27.78) Native pulmonary valve 3 (3.33) Prosthetic aortic valve 12 (13.33) Prosthetic mitral valve 14 (15.56) Prosthetic tricuspid valve 2 (2.22) Ventricular septal defect 1 (1.11) Pacemaker lead 5 (5.55) Left ventricular outflow tract 1 (1.11) Left heart side 55 (61.11) Right heart side 32 (35.56) Both heart sides 3 (27.78) Table 5. Antimicrobial therapy data Antimicrobial therapy n (%) Antimicrobials taken before admission Amoxicillin 2 (2.22) Ceftriaxone 26 (28.89) Ciprofloxacin 15 (16.67) Levofloxacin 35 (38.89) Vancomycin 1 (1.11) Rifampicin 2 (2.22) None 27 (30) Antimicrobials during admission Ceftriaxone 8 (8.89) Tazobactam 2 (2.22) Ampicillin/sulbactam 18 (20) Teicoplanin 2 (2.22) Vancomycin 79 (87.78) Gentamycin 82 (91.11) Rifampicin 10 (11.11) Cotrimoxazole 2 (2.22) Levofloxacin 7 (7.78) Doxycycline 1 (1.11) Table 6. Causes of in-hospital morbidity and mortality, and interventional surgery Causes and procedures Mean ± SD or n (%) In-hospital morbidity Embolic events 29 (32.22) Cerebrovascular 8 (8.89) Lower limb 8 (8.89) Renal artery 1 (1.11) Splenic 2 (2.22) Pulmonary 4 (4.44) More than one site 6 (6.67) Heart failure 18 (20) Septic shock 25 (27.78) Cardiogenic shock 8 (8.89) Acute kidney injury and renal failure 11 (12.22) Persistent fever 38 (42.22) New abscess 2 (2.22) Atrioventricular block 2 (2.22) Cardiac surgery and other interventional procedures Indicated 82 (91.11) Performed 26 (28.89) Not performed 56 (62.22) Days from admission to surgery 17.26 ± 9.19 EuroSCORE II 8.9 ± 13.2 Cause of non-performance Absence of surgery 12 (13.33) Patient refusal 17 (18.89) Death before surgery 27 (30) Procedure done Aortic valve replacement 8 (8.89) Mitral valve replacement 15 (16.67) Tricuspid valve replacement 2 (2.22) Surgical lead extraction 1 (1.11) Percutaneous lead extraction 4 (4.44) In-hospital mortality Number of deaths 31 (34.44) Cause of death Cardiac 2 (2.22) Non-cardiac 2 (2.22) Both 27 (30) Duration from admission to death (days) 19.19 ± 10 Pre-operative death 27 (30) Post-operative death 4 (4.44)
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