Is delayed surgery related to worse outcomes in native left-sided endocarditis?

Tepsuwan, Thitipong; Rimsukcharoenchai, Chartaroon; Tantraworasin, Apichat; Woragidpoonpol, Surin; Schuarattanapong, Suphachai; Nawarawong, Weerachai

doi:10.1177/0218492316637714

Cited by 2 publications

(3 citation statements)

References 16 publications

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“…In a recent meta‐analysis, patients operated for left‐sided endocarditis within 7 days after diagnosis had better survival in comparison to patients operated later or managed medically . However, in some retrospective studies, the benefit of ES has been questioned . In our study, even though patients operated within 7 days of prior directed antimicrobial treatment had a higher frequency of acute heart failure and emergency surgery, their 30‐day and late mortality were compared with patients operated later.…”

Section: Discussionsupporting

confidence: 61%

“…12 However, in some retrospective studies, the benefit of ES has been questioned. 13,14 In our study, even though patients operated within 7 days of prior directed antimicrobial treatment had a higher frequency of acute heart failure and emergency surgery, their 30-day and late mortality were compared with patients operated later. In the randomized Early Surgery versus Conventional Treatment for Infective endocarditis (EASE) study, surgery within 48 hours for IE was shown to decrease the composite endpoint of death from any cause and embolic events.…”

Section: Discussionmentioning

confidence: 74%

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Outcome of early vs delayed surgery for infective mitral endocarditis

2019

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Background and aim of the study Timing of surgery for infective endocarditis is controversial. The objective of this study was to report the outcomes of early vs delayed surgery (DS) of mitral endocarditis. Methods We retrospectively reviewed all patients treated surgically for mitral endocarditis between 2005 and 2016 in a single center. We analyzed midterm outcomes of early surgery (ES; surgery within 7 days or less of prior directed antibiotic treatment) in comparison to DS (surgery after more than 7 days of prior directed antibiotic treatment). Results Survival of all patients was 87% at one and 72% at 5 years. Mean follow‐up time was 4.0 ± 3.1 years. Thirty‐three (36.3%) patients were in the ES and 58 (63.7%) were in the DS group. Patients with ES were younger (47.4 vs 55.3 years), were in New York Heart Association class III or IV more frequently (97.0 vs 65.5%), and had higher EuroScore2 (15.6 vs 8.6%). The ES group had lower freedom from valve reoperation (98.2 vs 87.2%; P = .035) and the composite endpoint of >2 + regurgitation or reoperation at 5 years (98.2 vs 72.7%; P = .004). Conclusions ES was associated with a higher rate of reoperations and the composite endpoint of recurrent MR or reoperation.

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Section: Discussionsupporting

confidence: 61%

Section: Discussionmentioning

confidence: 74%

Outcome of early vs delayed surgery for infective mitral endocarditis

2019

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“…In our patients, stroke was associated with a four-times higher risk of death. Although it remains unclear whether early cardiac surgery improves the prognoses of patients, optimal timing seems to be of great importance (34,35). Compared with conventional treatment, an early surgery strategy may be associated with improved clinical outcomes by effectively decreasing systemic embolism in patients with IE (36).…”

Section: In-hospital Mortalitymentioning

confidence: 99%

Clinical predictors of complications in patients with left–sided infective endocarditis: A retrospective study of 206 episodes

Pazderník¹,

Wohlfahrt²,

Kautzner³

et al. 2019

BLL

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PURPOSE: Early identifi cation of specifi c patient subgroups at high risk of developing life-threatening infective endocarditis (IE) complications is of paramount importance. Better stratifi cation may allow more intensive treatment of these patients and positively infl uences clinical outcomes. METHODS: We carried out a retrospective survey of consecutive left-sided IE adult patients, admitted over a 15-year period to two main tertiary care centres in the Czech Republic. RESULTS: Among a group of 196 patients (155 males; median age 64 years), a total of 206 left-sided IE episodes were identifi ed. Perivalvular extension of infection was most frequently seen in prosthetic aortic valve endocarditis (OR 6.706, p < 0.0001). Valve prolapse/perforation during IE episodes was signifi cantly associated with mitral valve IE (OR 2.136, p = 0.026) and vegetation length (OR 1.055, p = 0.009). Septic shock was signifi cantly related to two main risk factors: S. aureus infection (OR 8.459, p = < 0.0001) and smoking (OR 8.403, p=0.001). Mitral valve IE with a vegetation length ≥13 mm was the strongest risk factor for this complication (OR 3.24, p=0.001), followed by S. aureus infection (OR 3.59, p = 0.002). Finally, septic shock (OR 6.000, p = 0.001) represented the most important risk factor of in-hospital mortality. CONCLUSIONS: This study provides the most detailed profi le of complication predictors related to left-sided IE in Central Europe. Early individual stratifi cation of IE related occurrence of complications might help to decrease extremely high morbidity and mortality of this disease (Tab. 5, Ref. 37).

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Is delayed surgery related to worse outcomes in native left-sided endocarditis?

Abstract: Delayed surgery is not associated with worse outcomes. Both early and delayed approaches are safe and provide acceptable results. Timing of surgery should be tailored to each patient's clinical status, not based on duration of endocarditis alone.

Cited by 2 publications

References 16 publications

Outcome of early vs delayed surgery for infective mitral endocarditis

Outcome of early vs delayed surgery for infective mitral endocarditis

Clinical predictors of complications in patients with left–sided infective endocarditis: A retrospective study of 206 episodes

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