Vivian H Chu1, Lawrence P Park2, Eugene Athan2, Francois Delahaye2, Tomas Freiberger2, Cristiane Lamas2, Jose M Miro2, Daniel W Mudrick2, Jacob Strahilevitz2, Christophe Tribouilloy2, Emanuele Durante-Mangoni2, Juan M Pericas2, Nuria Fernández-Hidalgo2, Francisco Nacinovich2, Hussien Rizk2, Vladimir Krajinovic2, Efthymia Giannitsioti2, John P Hurley2, Margaret M Hannan2, Andrew Wang2. 1. From Duke University Medical Center, Durham, NC (V.H.C., L.P.P., A.W.); Barwon Health and Deakin University, Geelong, Australia (E.A.); Hospital Louis Pradel, Lyon-Bron, France (F.D.); Center for Cardiovascular Surgery and Transplantation, Brno, and Central European Institute of Technology, Masaryk University, Brno, Czech Republic (T.F.); Instituto Nacional de Cardiologia, and Unigranrio, Rio de Janeiro, Brazil (C.L.); Infectious Diseases Service, Hospital Clinic-August Pi i Sunyer Biomedical Research Institute, University of Barcelona, Barcelona, Spain (J.M.M., J.M.P.); OhioHealth Heart and Vascular Physicians, Columbus, OH (D.W.M.); Hadassah-Hebrew University Medical Center, Jerusalem, Israel (J.S.); University Hospital, Amiens, and INSERM U-1088, University of Picardie, Amiens, France (C.T.); Internal Medicine, University of Naples SUN, Monaldi Hospital, Naples, Italy (E.D.-M.); Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (N.F.-H.); Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina (F.N.); Cairo University Hospital, Cairo, Egypt (H.R.); University Hospital for Infectious Diseases, Zagreb, Croatia (V.K.); Attikon University General Hospital, Athens, Greece (E.G.); and Mater Misericordiae University Hospital, Dublin, Ireland (J.P.H., M.M.H.). vivian.chu@duke.edu. 2. From Duke University Medical Center, Durham, NC (V.H.C., L.P.P., A.W.); Barwon Health and Deakin University, Geelong, Australia (E.A.); Hospital Louis Pradel, Lyon-Bron, France (F.D.); Center for Cardiovascular Surgery and Transplantation, Brno, and Central European Institute of Technology, Masaryk University, Brno, Czech Republic (T.F.); Instituto Nacional de Cardiologia, and Unigranrio, Rio de Janeiro, Brazil (C.L.); Infectious Diseases Service, Hospital Clinic-August Pi i Sunyer Biomedical Research Institute, University of Barcelona, Barcelona, Spain (J.M.M., J.M.P.); OhioHealth Heart and Vascular Physicians, Columbus, OH (D.W.M.); Hadassah-Hebrew University Medical Center, Jerusalem, Israel (J.S.); University Hospital, Amiens, and INSERM U-1088, University of Picardie, Amiens, France (C.T.); Internal Medicine, University of Naples SUN, Monaldi Hospital, Naples, Italy (E.D.-M.); Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (N.F.-H.); Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina (F.N.); Cairo University Hospital, Cairo, Egypt (H.R.); University Hospital for Infectious Diseases, Zagreb, Croatia (V.K.); Attikon University General Hospital, Athens, Greece (E.G.); and Mater Misericordiae University Hospital, Dublin, Ireland (J.P.H., M.M.H.).
Abstract
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.
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.
Authors: Emelia J Benjamin; Michael J Blaha; Stephanie E Chiuve; Mary Cushman; Sandeep R Das; Rajat Deo; Sarah D de Ferranti; James Floyd; Myriam Fornage; Cathleen Gillespie; Carmen R Isasi; Monik C Jiménez; Lori Chaffin Jordan; Suzanne E Judd; Daniel Lackland; Judith H Lichtman; Lynda Lisabeth; Simin Liu; Chris T Longenecker; Rachel H Mackey; Kunihiro Matsushita; Dariush Mozaffarian; Michael E Mussolino; Khurram Nasir; Robert W Neumar; Latha Palaniappan; Dilip K Pandey; Ravi R Thiagarajan; Mathew J Reeves; Matthew Ritchey; Carlos J Rodriguez; Gregory A Roth; Wayne D Rosamond; Comilla Sasson; Amytis Towfighi; Connie W Tsao; Melanie B Turner; Salim S Virani; Jenifer H Voeks; Joshua Z Willey; John T Wilkins; Jason Hy Wu; Heather M Alger; Sally S Wong; Paul Muntner Journal: Circulation Date: 2017-01-25 Impact factor: 29.690