Manuel Martínez-Sellés1, Patricia Muñoz2, Ana Arnáiz3, Mar Moreno4, Juan Gálvez5, Jorge Rodríguez-Roda6, Arístides de Alarcón7, Emilio García Cabrera7, María C Fariñas8, José M Miró9, Miguel Montejo10, Alfonso Moreno11, Josefa Ruiz-Morales12, Miguel A Goenaga13, Emilio Bouza2. 1. Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Universidad Europea de Madrid, Spain. Electronic address: mmselles@secardiologia.es. 2. Department of Clinical Microbiology Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Universidad Complutense de Madrid, Spain. 3. Department of Internal Medicine, Hospital Universitario Marqués de Valdecilla, Santander, Spain. 4. Department of Cardiology, Hospital Universitario La Paz, Madrid, Spain. 5. Department of Clinical Microbiology and Infectious Diseases, Hospital Universitario Virgen Macarena, Sevilla, Spain. 6. Department of Cardiovascular Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain. 7. Department of Clinical Microbiology and Infectious Diseases, Hospital Universitario Virgen del Rocío, Sevilla, Spain. 8. Department of Clinical Microbiology and Infectious Diseases, Hospital Universitario Marqués de Valdecilla, Santander, Spain. 9. Department of Clinical Microbiology and Infectious Diseases, Hospital Universitario Clínic de Barcelona, Spain; Universidad de Barcelona, Spain. 10. Department of Clinical Microbiology and Infectious Diseases, Hospital Universitario Cruces, Bilbao, Spain; Universidad del País Vasco, Spain. 11. Department of Clinical Microbiology and Infectious Diseases, Hospital Universitario Central de Asturias, Oviedo, Spain. 12. Department of Internal Medicine, Hospital Universitario Virgen de la Victoria, Málaga, Spain. 13. Department of Clinical Microbiology and Infectious Diseases, Hospital Universitario Donosti, San Sebastián, Spain.
Abstract
AIMS: Surgery for infective endocarditis (IE) is associated with high mortality. Our objectives were to describe the experience with surgical treatment for IE in Spain, and to identify predictors of in-hospital mortality. METHODS: Prospective cohort of 1000 consecutive patients with IE. Data were collected in 26 Spanish hospitals. RESULTS: Surgery was performed in 437 patients (43.7%). Patients treated with surgery were younger and predominantly male. They presented fewer comorbid conditions and more often had negative blood cultures and heart failure. In-hospital mortality after surgery was lower than in the medical therapy group (24.3 vs 30.7%, p=0.02). In patients treated with surgery, endocarditis involved a native valve in 267 patients (61.1%), a prosthetic valve in 122 (27.9%), and a pacemaker lead with no clear further valve involvement in 48 (11.0%). The most common aetiologies were Staphylococcus (186, 42.6%), Streptococcus (97, 22.2%), and Enterococcus (49, 11.2%). The main indications for surgery were heart failure and severe valve regurgitation. A risk score for in-hospital mortality was developed using 7 prognostic variables with a similar predictive value (OR between 1.7 and 2.3): PALSUSE: prosthetic valve, age ≥ 70, large intracardiac destruction, Staphylococcus spp, urgent surgery, sex [female], EuroSCORE ≥ 10. In-hospital mortality ranged from 0% in patients with a PALSUSE score of 0 to 45.4% in patients with PALSUSE score >3. CONCLUSIONS: The prognosis of IE surgery is highly variable. The PALSUSE score could help to identify patients with higher in-hospital mortality.
AIMS: Surgery for infective endocarditis (IE) is associated with high mortality. Our objectives were to describe the experience with surgical treatment for IE in Spain, and to identify predictors of in-hospital mortality. METHODS: Prospective cohort of 1000 consecutive patients with IE. Data were collected in 26 Spanish hospitals. RESULTS: Surgery was performed in 437 patients (43.7%). Patients treated with surgery were younger and predominantly male. They presented fewer comorbid conditions and more often had negative blood cultures and heart failure. In-hospital mortality after surgery was lower than in the medical therapy group (24.3 vs 30.7%, p=0.02). In patients treated with surgery, endocarditis involved a native valve in 267 patients (61.1%), a prosthetic valve in 122 (27.9%), and a pacemaker lead with no clear further valve involvement in 48 (11.0%). The most common aetiologies were Staphylococcus (186, 42.6%), Streptococcus (97, 22.2%), and Enterococcus (49, 11.2%). The main indications for surgery were heart failure and severe valve regurgitation. A risk score for in-hospital mortality was developed using 7 prognostic variables with a similar predictive value (OR between 1.7 and 2.3): PALSUSE: prosthetic valve, age ≥ 70, large intracardiac destruction, Staphylococcus spp, urgent surgery, sex [female], EuroSCORE ≥ 10. In-hospital mortality ranged from 0% in patients with a PALSUSE score of 0 to 45.4% in patients with PALSUSE score >3. CONCLUSIONS: The prognosis of IE surgery is highly variable. The PALSUSE score could help to identify patients with higher in-hospital mortality.
Authors: Giuseppe Gatti; Andrea Perrotti; Jean-François Obadia; Xavier Duval; Bernard Iung; François Alla; Catherine Chirouze; Christine Selton-Suty; Bruno Hoen; Gianfranco Sinagra; François Delahaye; Pierre Tattevin; Vincent Le Moing; Aniello Pappalardo; Sidney Chocron Journal: J Am Heart Assoc Date: 2017-07-20 Impact factor: 5.501
Authors: Yuka Kiyota; Alessandro Della Corte; Vanessa Montiero Vieira; Karam Habchi; Chuan-Chin Huang; Ester E Della Ratta; Thoralf M Sundt; Prem Shekar; Jochen D Muehlschlegel; Simon C Body Journal: Open Heart Date: 2017-05-16