OBJECTIVES: We studied a contemporary cohort of adult patients treated surgically for infective endocarditis (IE) in order to evaluate the surgical approach and predictors of outcomes, in relation to the intercurrent adaptation of the 2006 ACC/AHA guidelines. METHODS: One hundred and eighty-six consecutive patients operated on for active IE from August 1999 to September 2012 were reviewed retrospectively. Clinical presentation, surgical management and outcomes in the two study periods before and after January 2007 were compared (Period 1: n = 95 and Period 2: n = 91). RESULTS: The mean (SD) follow-up was 4.3 (3.8) years and was 99.5% complete. Patients in Period 2 had more frequently associated coronary artery disease (31 vs 18%, P = 0.06), while the microbiology revealed more Staphylococcus species (43 vs 26%, P = 0.02), predominantly Staphylococcus aureus (31 vs 19%; P = 0.07), and less culture-negative cases (7 vs 17%; P = 0.05). The median delay between diagnosis and surgery was 7 days in Period 2 compared with 14 days in Period 1 (P = 0.001). Surgery in Period 2 included more root replacements for aortic valve endocarditis (11 vs 2%; P = 0.02) and mitral valve repairs (18 vs 5%; P = 0.01), while the use of homografts for aortic valve endocarditis was almost abandoned (1 vs 15%; P = 0.001). Hospital mortality was 13% and did not change significantly over both periods (P = 0.66). The independent predictors of hospital mortality were age (P = 0.03), female gender (P = 0.02), previous cardiac surgery (P = 0.02), preoperative serum creatinine level >2 mg/dl (P = 0.05), S. aureus infection (P = 0.02), emergent or salvage operation (P = 0.001) and concomitant coronary artery bypass grafting (P = 0.03). The 1-, 3-, 5- and 10-year survival were 84, 72, 64 and 57%, respectively. Late survival was negatively influenced by S. aureus endocarditis (P < 0.001) and peripheral vascular disease (P = 0.03), whereas associated coronary artery disease (P = 0.07) had a strong impact. CONCLUSIONS: Adaptation of the 2006 ACC/AHA guidelines in the contemporary management of IE led to a shorter interval between diagnosis and surgery. Despite a more extensive and earlier operative approach, IE caused by S. aureus still remains a major determinant of early and late outcomes.
OBJECTIVES: We studied a contemporary cohort of adult patients treated surgically for infective endocarditis (IE) in order to evaluate the surgical approach and predictors of outcomes, in relation to the intercurrent adaptation of the 2006 ACC/AHA guidelines. METHODS: One hundred and eighty-six consecutive patients operated on for active IE from August 1999 to September 2012 were reviewed retrospectively. Clinical presentation, surgical management and outcomes in the two study periods before and after January 2007 were compared (Period 1: n = 95 and Period 2: n = 91). RESULTS: The mean (SD) follow-up was 4.3 (3.8) years and was 99.5% complete. Patients in Period 2 had more frequently associated coronary artery disease (31 vs 18%, P = 0.06), while the microbiology revealed more Staphylococcus species (43 vs 26%, P = 0.02), predominantly Staphylococcus aureus (31 vs 19%; P = 0.07), and less culture-negative cases (7 vs 17%; P = 0.05). The median delay between diagnosis and surgery was 7 days in Period 2 compared with 14 days in Period 1 (P = 0.001). Surgery in Period 2 included more root replacements for aortic valve endocarditis (11 vs 2%; P = 0.02) and mitral valve repairs (18 vs 5%; P = 0.01), while the use of homografts for aortic valve endocarditis was almost abandoned (1 vs 15%; P = 0.001). Hospital mortality was 13% and did not change significantly over both periods (P = 0.66). The independent predictors of hospital mortality were age (P = 0.03), female gender (P = 0.02), previous cardiac surgery (P = 0.02), preoperative serum creatinine level >2 mg/dl (P = 0.05), S. aureus infection (P = 0.02), emergent or salvage operation (P = 0.001) and concomitant coronary artery bypass grafting (P = 0.03). The 1-, 3-, 5- and 10-year survival were 84, 72, 64 and 57%, respectively. Late survival was negatively influenced by S. aureus endocarditis (P < 0.001) and peripheral vascular disease (P = 0.03), whereas associated coronary artery disease (P = 0.07) had a strong impact. CONCLUSIONS: Adaptation of the 2006 ACC/AHA guidelines in the contemporary management of IE led to a shorter interval between diagnosis and surgery. Despite a more extensive and earlier operative approach, IE caused by S. aureus still remains a major determinant of early and late outcomes.
Authors: Harm H H Feringa; Leslee J Shaw; Don Poldermans; Sanne Hoeks; Ernst E van der Wall; Robert A E Dion; Jeroen J Bax Journal: Ann Thorac Surg Date: 2007-02 Impact factor: 4.330
Authors: Ignasi Anguera; Jose M Miro; Christopher H Cabell; Elias Abrutyn; Vance G Fowler; Bruno Hoen; Lars Olaison; Paul A Pappas; Elisa de Lazzari; Susannah Eykyn; Gilbert Habib; Carles Pare; Andrew Wang; Ralph Corey Journal: Am J Cardiol Date: 2005-10-01 Impact factor: 2.778
Authors: Tirone E David; Gheorghe Gavra; Christopher M Feindel; Tommaso Regesta; Susan Armstrong; Manjula D Maganti Journal: J Thorac Cardiovasc Surg Date: 2006-11-30 Impact factor: 5.209
Authors: Robert O Bonow; Blase A Carabello; Chatterjee Kanu; Antonio C de Leon; David P Faxon; Michael D Freed; William H Gaasch; Bruce Whitney Lytle; Rick A Nishimura; Patrick T O'Gara; Robert A O'Rourke; Catherine M Otto; Pravin M Shah; Jack S Shanewise; Sidney C Smith; Alice K Jacobs; Cynthia D Adams; Jeffrey L Anderson; Elliott M Antman; David P Faxon; Valentin Fuster; Jonathan L Halperin; Loren F Hiratzka; Sharon A Hunt; Bruce W Lytle; Rick Nishimura; Richard L Page; Barbara Riegel Journal: Circulation Date: 2006-08-01 Impact factor: 29.690
Authors: David R Murdoch; G Ralph Corey; Bruno Hoen; José M Miró; Vance G Fowler; Arnold S Bayer; Adolf W Karchmer; Lars Olaison; Paul A Pappas; Philippe Moreillon; Stephen T Chambers; Vivian H Chu; Vicenç Falcó; David J Holland; Philip Jones; John L Klein; Nigel J Raymond; Kerry M Read; Marie Francoise Tripodi; Riccardo Utili; Andrew Wang; Christopher W Woods; Christopher H Cabell Journal: Arch Intern Med Date: 2009-03-09
Authors: Gilbert Habib; Bruno Hoen; Pilar Tornos; Franck Thuny; Bernard Prendergast; Isidre Vilacosta; Philippe Moreillon; Manuel de Jesus Antunes; Ulf Thilen; John Lekakis; Maria Lengyel; Ludwig Müller; Christoph K Naber; Petros Nihoyannopoulos; Anton Moritz; Jose Luis Zamorano Journal: Eur Heart J Date: 2009-08-27 Impact factor: 29.983
Authors: Christopher S Stach; Bao G Vu; Joseph A Merriman; Alfa Herrera; Michael P Cahill; Patrick M Schlievert; Wilmara Salgado-Pabón Journal: PLoS One Date: 2016-04-28 Impact factor: 3.240