Association between surgical indications, operative risk, and clinical outcome in infective endocarditis: a prospective study from the International Collaboration on Endocarditis.

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.

[1]  Thoralf M Sundt,et al.  2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. , 2014, Circulation.

[2]  Thoralf M Sundt,et al.  2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. , 2014, Circulation.

[3]  G. Gamble,et al.  Valvular repair or replacement for mitral endocarditis: 7-year cohort study , 2014, Asian cardiovascular & thoracic annals.

[4]  V. Figueredo,et al.  Infective Endocarditis Epidemiology Over Five Decades: A Systematic Review , 2013, PloS one.

[5]  S. Antinori,et al.  Profile of infective endocarditis observed from 2003 - 2010 in a single center in Italy , 2013, BMC Infectious Diseases.

[6]  F. Chirillo,et al.  Management of patients with infective endocarditis by a multidisciplinary team approach: an operative protocol , 2013, Journal of cardiovascular medicine.

[7]  C. Hidalgo-Tenorio,et al.  Neurological Complications of Infective Endocarditis: Risk Factors, Outcome, and Impact of Cardiac Surgery A Multicenter Observational Study , 2013, Circulation.

[8]  D. Himmelstein,et al.  Infective Endocarditis in the U.S., 1998–2009: A Nationwide Study , 2013, PloS one.

[9]  L. Olaison,et al.  Influence of the timing of cardiac surgery on the outcome of patients with infective endocarditis and stroke. , 2013, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[10]  F. Alla,et al.  Preeminence of Staphylococcus aureus in infective endocarditis: a 1-year population-based survey. , 2012, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[11]  A. Della Corte,et al.  The Need for a Specific Risk Prediction System in Native Valve Infective Endocarditis Surgery , 2012, TheScientificWorldJournal.

[12]  F. Alla,et al.  The impact of valve surgery on short- and long-term mortality in left-sided infective endocarditis: do differences in methodological approaches explain previous conflicting results? , 2011, European heart journal.

[13]  S. Prabhakaran,et al.  Surgical management of endocarditis: the society of thoracic surgeons clinical practice guideline. , 2011, The Annals of thoracic surgery.

[14]  V. Fowler,et al.  Analysis of the Impact of Early Surgery on In-Hospital Mortality of Native Valve Endocarditis: Use of Propensity Score and Instrumental Variable Methods to Adjust for Treatment-Selection Bias , 2010, Circulation.

[15]  D. Raoult,et al.  Dramatic reduction in infective endocarditis-related mortality with a management-based approach. , 2009, Archives of internal medicine.

[16]  A. Kamarulzaman.  International Collaboration on Endocarditis-Prospective Cohort Study(ICE-PCS) Investigators. Clinical presentation, etiology, and outcome ofinfective endocarditis in the 21st century: the International Collaboration onEndocarditis-Prospective Cohort Study , 2009 .

[17]  Gilbert Habib,et al.  Health care-associated native valve endocarditis: importance of non-nosocomial acquisition. , 2009, Annals of internal medicine.

[18]  Andrew Wang,et al.  Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the International Collaboration on Endocarditis-Prospective Cohort Study. , 2009, Archives of internal medicine.

[19]  A. Kamarulzaman.  International Collaboration on Endocarditis Prospective Cohort Study , 2008 .

[20]  Stamatios Lerakis,et al.  The relationship between the initiation of antimicrobial therapy and the incidence of stroke in infective endocarditis: an analysis from the ICE Prospective Cohort Study (ICE-PCS). , 2007, American heart journal.

[21]  Kent R Bailey,et al.  A systematic review of population-based studies of infective endocarditis. , 2007, Chest.

[22]  Patricia Muñoz,et al.  Contemporary clinical profile and outcome of prosthetic valve endocarditis. , 2007, JAMA.

[23]  Bruno Hoen,et al.  The use and effect of surgical therapy for prosthetic valve infective endocarditis: a propensity analysis of a multicenter, international cohort. , 2005, American heart journal.

[24]  Walter R Wilson,et al.  Temporal trends in infective endocarditis: a population-based study in Olmsted County, Minnesota. , 2005, JAMA.

[25]  K. Anstrom,et al.  Staphylococcus aureus endocarditis: a consequence of medical progress. , 2005, JAMA.

[26]  J. Weber,et al.  Timing the valve replacement in infective endocarditis involving the brain , 2004, Journal of Neurology.

[27]  A. Pavie,et al.  [Guidelines on prevention, diagnosis and treatment of infective endocarditis. Executive summary]. , 2004, Revista espanola de cardiologia.

[28]  Joan Buenconsejo,et al.  Impact of valve surgery on 6-month mortality in adults with complicated, left-sided native valve endocarditis: a propensity analysis. , 2003, JAMA.

[29]  C. Cabell,et al.  Progress toward a global understanding of infective endocarditis. Lessons from the International Collaboration on Endocarditis. , 2003, Cardiology clinics.

[30]  G. Baron,et al.  Infective endocarditis in Europe: lessons from the Euro heart survey , 2003, Heart.

[31]  Daniel J Sexton,et al.  Health CareAssociated Bloodstream Infections in Adults: A Reason To Change the Accepted Definition of Community-Acquired Infections , 2002, Annals of Internal Medicine.

[32]  C. Cabell,et al.  Progress toward a global understanding of infective endocarditis. Early lessons from the International Collaboration on Endocarditis investigation. , 2002, Infectious disease clinics of North America.

[33]  D. Mesa,et al.  Long term outcome of infective endocarditis in patients who were not drug addicts: a 10 year study , 2000, Heart.

[34]  V. Fowler,et al.  Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. , 2000, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[35]  Y. Kawashima,et al.  Surgical management of infective endocarditis associated with cerebral complications. Multi-center retrospective study in Japan. , 1995, The Journal of thoracic and cardiovascular surgery.

[36]  R. Hart,et al.  Stroke in infective endocarditis. , 1990, Stroke.

[37]  Jennifer G. Robinson,et al.  ACCF/AHA TASK FORCE MEMBERS , 2013 .

[38]  C. Álvarez-Ortega.  [Early surgery versus conventional treatment for infective endocarditis]. , 2012, Revista clinica espanola.

[39]  Sean M. O'Brien,et al.  Outcomes for endocarditis surgery in North America: a simplified risk scoring system. , 2011, The Journal of thoracic and cardiovascular surgery.

[40]  P. Seferovic.  The Task Force on the Prevention, Diagnosis, and Treatment of Infective Endocarditis of the European Society of Cardiology (ESC) , 2009 .

[41]  Dumc Box.  The use and effect of surgical therapy for prosthetic valve infective endocarditis: A propensity analysis of a multicenter, international cohort , 2006 .

[42]  M. Cheitlin.  Prosthetic Valve Endocarditis: Who Needs Surgery? A Multicentre Study of 104 Cases , 2006 .

[43]  M. Terpenning.  Infective endocarditis. , 1992, Clinics in geriatric medicine.