AIMS: To determine whether the timing of surgery could influence mortality and morbidity in adults with complicated infective endocarditis (IE). METHODS AND RESULTS: In 291 consecutive adults with definite IE who underwent surgery during the active phase, we compared those operated on within the first week of antimicrobial therapy (n=95) to those operated on later (n=191). The impact of the timing of surgery on 6-month mortality, relapses, and postoperative valvular dysfunctions (PVD) was analysed using propensity score (PS) analyses. After stratification of the cohort into quintiles based on the PS, ≤1st week surgery was associated with a trend of decrease in 6-month mortality in the quintile of patients with the most likelihood of undergoing this early surgical management [quintile 5: 11% vs. 33%, odds ratio (OR)=0.18, 95% CI (confidence interval) 0.04-0.83, P=0.03]. Patients of this subgroup were younger, were more likely to have Staphylococcus aureus infections, congestive heart failure, and larger vegetations. Besides, ≤1st week surgery was associated with an increased number of relapses or PVD (16% vs. 4%, adjusted OR=2.9, 95% CI 0.99-8.40, P=0.05). CONCLUSION: Surgery performed very early may improve survival in patients with the most severe complicated IE. However, a greater risk of relapses and PVD should be expected when surgery is performed very early.
AIMS: To determine whether the timing of surgery could influence mortality and morbidity in adults with complicated infective endocarditis (IE). METHODS AND RESULTS: In 291 consecutive adults with definite IE who underwent surgery during the active phase, we compared those operated on within the first week of antimicrobial therapy (n=95) to those operated on later (n=191). The impact of the timing of surgery on 6-month mortality, relapses, and postoperative valvular dysfunctions (PVD) was analysed using propensity score (PS) analyses. After stratification of the cohort into quintiles based on the PS, ≤1st week surgery was associated with a trend of decrease in 6-month mortality in the quintile of patients with the most likelihood of undergoing this early surgical management [quintile 5: 11% vs. 33%, odds ratio (OR)=0.18, 95% CI (confidence interval) 0.04-0.83, P=0.03]. Patients of this subgroup were younger, were more likely to have Staphylococcus aureus infections, congestive heart failure, and larger vegetations. Besides, ≤1st week surgery was associated with an increased number of relapses or PVD (16% vs. 4%, adjusted OR=2.9, 95% CI 0.99-8.40, P=0.05). CONCLUSION: Surgery performed very early may improve survival in patients with the most severe complicated IE. However, a greater risk of relapses and PVD should be expected when surgery is performed very early.
Authors: T Ris; A Teixeira-Carvalho; R Matos Pinto Coelho; C Brandao-de-Resende; M Souza Gomes; L Rodrigues Amaral; P H Oliveira Murta Pinto; L J Souza Santos; J Teixeira Salles; Jolien Roos-Hesselink; N Verkaik; T Cristina Abreu Ferrari; M C Pereira Nunes Journal: Clin Exp Immunol Date: 2019-02-17 Impact factor: 4.330
Authors: Trine K Lauridsen; Kasper K Iversen; Nikolaj Ihlemann; Philip Hasbak; Annika Loft; Anne K Berthelsen; Anders Dahl; Danijela Dejanovic; Elisabeth Albrecht-Beste; Jann Mortensen; Andreas Kjær; Henning Bundgaard; Niels Eske Bruun Journal: Int J Cardiovasc Imaging Date: 2017-01-03 Impact factor: 2.357
Authors: Mahmoud Diab; Albrecht Guenther; Christoph Sponholz; Thomas Lehmann; Gloria Faerber; Anna Matz; Marcus Franz; Otto W Witte; Mathias W Pletz; Torsten Doenst Journal: Clin Res Cardiol Date: 2016-04-27 Impact factor: 5.460
Authors: Jan Smid; Maximilian Scherner; Oliver Wolfram; Thomas Groscheck; Jens Wippermann; Rüdiger C Braun-Dullaeus Journal: Dtsch Arztebl Int Date: 2018-03-23 Impact factor: 5.594