Early Surgery versus Conventional Treatment for Infective Endocarditis

Kang, Duk–Hyun; Kim, Yong-Jin; Kim, Sung-Han; Sun, Byung Joo; Kim, Dae–Hee; Yun, Sangwon; Song, Jong-Min; Choo, Suk Jung; Chung, Cheol Hyun; Song, Jae‐Kwan; Lee, Jae Won; Sohn, Dae-Won

doi:10.1056/nejmoa1112843

Cited by 714 publications

(457 citation statements)

References 21 publications

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“…There is only 1 randomized study in patients with native valve endocarditis showing that early surgery (within 48 hours) compared with conventional treatment (77% of patients receiving surgery beyond 48 hours) reduced the risk of the composite end point of embolic events and in‐hospital mortality within 6 weeks, with no difference in all‐cause mortality after 6 months 10. In our study, the median time from diagnosis to CS was 17 days (25th–75th percentile, 4–35 days).…”

Section: Discussionmentioning

confidence: 99%

“…In those cohorts, surgery is performed in 50% of cases8 in contrast to the 10.8% rate of surgical valve explantation observed in the multicenter registry,7 despite a high rate (>80%) of patients with at least 1 indication for surgery, according to current guidelines 9. Early surgery in patients with native valve endocarditis and severe valve dysfunction or large vegetations reduces the risk of the combined end point of in‐hospital death and embolic events 10. In PVE, the best therapeutic option is still debated, with studies showing improved survival after early valve replacement11 and those showing no benefit of surgery compared with medical treatment after adjustment for differences in clinical characteristics and survival bias 12.…”

Section: Introductionmentioning

confidence: 99%

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Cardiac Surgery Compared With Antibiotics Only in Patients Developing Infective Endocarditis After Transcatheter Aortic Valve Replacement

Leontyev

Woitek

Kiefer

et al. 2018

JAHA

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BackgroundInfective endocarditis (IE) after transcatheter aortic valve replacement is a devastating complication associated with a high mortality. Our objective was to determine the impact of cardiac surgery (CS) and antibiotics (IE‐CS) compared with medical treatment with antibiotics only (IE‐ABx) on 1‐year mortality in patients developing IE after transcatheter aortic valve replacement.Methods and ResultsPatients developing IE after transcatheter aortic valve replacement were included in this retrospective analysis. All‐cause 1‐year mortality was the primary end point. A total of 20 patients underwent IE‐CS compared with 44 patients treated by IE‐ABx. In this unmatched cohort, patients treated by IE‐ABx were older (P=0.006), had a higher Society of Thoracic Surgeons score (P=0.029), and more often had severe chronic kidney disease (P=0.037). One‐year mortality was not different between groups (IE‐CS versus IE‐ABx, 65% versus 68.2%; P=0.802). The rate of any complication during treatment was higher in the IE‐CS group (P=0.024). In a matched cohort, baseline characteristics were not significantly different. All‐cause 1‐year mortality was not different between groups (IE‐CS versus IE‐ABx, 65% versus 75%; P=0.490). A Cox regression analysis revealed any indication for surgery (hazard ratio, 6.20; 95% confidence interval, 1.80–21.41; P=0.004), sepsis on admission (hazard ratio, 4.03; 95% confidence interval, 1.97–8.24; P<0.001), and mitral regurgitation ≥2 (hazard ratio, 2.91; 95% confidence interval, 1.33–6.37) as factors associated with 1‐year mortality.ConclusionsIn patients developing IE after transcatheter aortic valve replacement, mortality was predicted by the severity of IE and concomitant mitral regurgitation. In this small, and therefore statistically limited, but high‐risk patient cohort, CS provided no significant mortality benefit compared with medical therapy. Individual decision making by a “heart and endocarditis team” is necessary to offer those patients the most reasonable treatment option.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cardiac Surgery Compared With Antibiotics Only in Patients Developing Infective Endocarditis After Transcatheter Aortic Valve Replacement

Leontyev

Woitek

Kiefer

et al. 2018

JAHA

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“…[37][38][39][40] The antimicrobial regimens employed, mean hospital stay and surgical intervention rates are summarised in Table 1 and discussed below.…”

Section: Treatmentmentioning

confidence: 99%

“…23 Among patients with complications that require emergent intervention, the optimal timing for surgery remains controversial. 45 Early surgery however, has been shown to decrease the rate of embolic events, 46 in-hospital, 47 and 6-month mortality. 48 Two studies in our review reported on the timing of surgery.…”

Section: Surgical Managementmentioning

confidence: 99%

Infective Endocarditis in Low- and Middle-Income Countries

et al. 2017

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Key Points Staphylococcus is an increasingly important cause of IE in LMICs, and is the leading cause of IE in UMICs  RHD remains the major underlying cardiac pathology of IE in LMICs, identified in almost half of reported cases  The rate of microorganism non-identification is high, reaching up to 60% of IE cases in LMICs, and hampering diagnosis and treatment  Rates of access to surgery in UMICs for complicated IE are as high as in HICs, but remain dismal in lower-middle income countries SynopsisInfective endocarditis (IE) is a rare, life-threatening disease with a mortality rate of upto 25% and significant debilitating morbidities. Although much has been reported on contemporary IE in high income countries, conclusions on the state of IE in low and middle income countries (LMICs) are based on studies conducted before the year 2000. Furthermore, unique challenges in the diagnosis and management of IE persist in LMICs. This article is a review of IE studies conducted in LMICs documenting clinical experiences from the year 2000 to present. We present the causes of IE, management of patients with IE and the prevailing challenges in diagnosis and treatment of IE in LMICs.

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“…Early surgery is effective and advocated in infective endocarditis with large vegetations for primary prevention of embolic events in one randomised trial and international guidelines [1,2], but the optimal timing of surgery remains controversial in those with cerebral embolism, due to the sparse literature and absence of randomised studies. In this meta-analysis, outcomes of early or deferred infective endocarditis surgery with cerebral embolism was pooled and compared.…”

Section: Introductionmentioning

confidence: 99%

Early or Delayed Surgery for Infective Endocarditis Complicated by Cerebral Embolism: a Meta-analysis

Wang¹,

Pemberton²,

Wang³

2017

ICFJ

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Background: Surgery is recommended for infective endocarditis patients who develop cerebral embolism, however the optimal timing of surgery remains controversial. In this meta-analysis, we compared the outcomes of early and delayed cardiac surgery for infective endocarditis in this setting. Methods: PubMed, MEDLINE, Embase, Cochrane and Scopus databases from 1 January 1980 to 30 June 2016 were searched for original studies. Two authors evaluated these studies for inclusion independently, then extracted and pooled data using random-effects models. Results: Amongst 2,423 papers obtained from the search, 23 full-texts were reviewed, and 6 studies totalling 701 patients were included for analyses. Rates and pooled odds ratio (95% confidence interval) for operative mortality of early or late surgery set at 7 days were 13.5% vs 10.8%, 1.40 (0.61-3.02); 14 days were 20.7% vs 13.0%, 1.95 (0.95-4.01). Pooled odds ratio of early surgery for long-term mortality was 2.95 (0.35-25.0); and for neurological events, embolic event was 1.22 (0.33-4.56) and intracranial bleeding 1.55 (0.16-15.32). Conclusion: Although early surgery was not associated with statistically higher rates of mortality or neurological events it does need to be cautiously performed. Data is limited and larger and randomised studies would help to determine the optimal timing.

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Early Surgery versus Conventional Treatment for Infective Endocarditis

Cited by 714 publications

References 21 publications

Cardiac Surgery Compared With Antibiotics Only in Patients Developing Infective Endocarditis After Transcatheter Aortic Valve Replacement

Cardiac Surgery Compared With Antibiotics Only in Patients Developing Infective Endocarditis After Transcatheter Aortic Valve Replacement

Infective Endocarditis in Low- and Middle-Income Countries

Early or Delayed Surgery for Infective Endocarditis Complicated by Cerebral Embolism: a Meta-analysis

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