Association between surgical indications, operative risk, and clinical outcome in infective endocarditis: a prospective study from the International Collaboration on Endocarditis
Language English Country United States Media print-electronic
Document type Comparative Study, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't
PubMed
25480814
DOI
10.1161/circulationaha.114.012461
PII: CIRCULATIONAHA.114.012461
Knihovny.cz E-resources
- Keywords
- endocarditis, infection, mortality, surgery, valve,
- MeSH
- Abscess epidemiology MeSH
- Anti-Infective Agents therapeutic use MeSH
- Bacteremia drug therapy epidemiology MeSH
- Heart Valve Prosthesis Implantation statistics & numerical data MeSH
- Embolism etiology MeSH
- Endocarditis drug therapy mortality surgery MeSH
- Risk Assessment MeSH
- Cross Infection drug therapy mortality surgery MeSH
- Kaplan-Meier Estimate MeSH
- Comorbidity MeSH
- Middle Aged MeSH
- Humans MeSH
- Follow-Up Studies MeSH
- Postoperative Complications epidemiology MeSH
- Prognosis MeSH
- Prospective Studies MeSH
- Aged MeSH
- Heart Valves microbiology surgery MeSH
- Staphylococcal Infections drug therapy mortality MeSH
- Severity of Illness Index MeSH
- Models, Theoretical MeSH
- Patient Selection MeSH
- Treatment Outcome MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Research Support, Non-U.S. Gov't MeSH
- Comparative Study MeSH
- Names of Substances
- Anti-Infective Agents MeSH
BACKGROUND: Use of surgery for the treatment of infective endocarditis (IE) as related to surgical indications and operative risk for mortality has not been well defined. METHODS AND RESULTS: The International Collaboration on Endocarditis-PLUS (ICE-PLUS) is a prospective cohort of consecutively enrolled patients with definite IE from 29 centers in 16 countries. We included patients from ICE-PLUS with definite left-sided, non-cardiac device-related IE who were enrolled between September 1, 2008, and December 31, 2012. A total of 1296 patients with left-sided IE were included. Surgical treatment was performed in 57% of the overall cohort and in 76% of patients with a surgical indication. Reasons for nonsurgical treatment included poor prognosis (33.7%), hemodynamic instability (19.8%), death before surgery (23.3%), stroke (22.7%), and sepsis (21%). Among patients with a surgical indication, surgical treatment was independently associated with the presence of severe aortic regurgitation, abscess, embolization before surgical treatment, and transfer from an outside hospital. Variables associated with nonsurgical treatment were a history of moderate/severe liver disease, stroke before surgical decision, and Staphyloccus aureus etiology. The integration of surgical indication, Society of Thoracic Surgeons IE score, and use of surgery was associated with 6-month survival in IE. CONCLUSIONS: Surgical decision making in IE is largely consistent with established guidelines, although nearly one quarter of patients with surgical indications do not undergo surgery. Operative risk assessment by Society of Thoracic Surgeons IE score provides prognostic information for survival beyond the operative period. S aureus IE was significantly associated with nonsurgical management.
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