Mortality risk prediction in infective endocarditis surgery: reliability analysis of specific scores†

Varela, Laura; López-Menéndez, José; Redondo, Ana; Fajardo, Edmundo Ricardo; Hycka, Javier Miguelena; Centella, Tomasa; Martín, Miren; Muñoz, Rafael; Navas, Enrique; Moya, José Luís Medina; Rodríguez-Roda, Jorge

doi:10.1093/ejcts/ezx428

Cited by 36 publications

(29 citation statements)

References 22 publications

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“…The line between a correct indication for surgery and operative futility often can be arbitrary. There are a significant number of scores used to estimate the surgical risk in patients with IE, 13‐16 but their reliability has been questioned 17,18 . In our practice, a high estimated mortality risk using these scores has never been used to judge on operability.…”

Section: Discussionmentioning

confidence: 99%

The fate of active left‐side infective endocarditis with operative indication in absence of valve surgery

Carino

Fernández-Cisneros

Hernández‐Meneses

et al. 2020

Journal of Cardiac Surgery

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Objectives: Although the benefits of surgery in infective endocarditis (IE) are clear, an unneglectable proportion of patients do not undergo surgery despite clear operative indication. Outcomes of these patients are poorly reported. With this study, we aim to analyze patient profiles, indication for surgery, decision-making, and outcomes of patients not undergoing surgery despite contemporary surgical indications. Materials and Methods: Retrospective review of single institution database of patients with IE was done to identify patients that, although a clear surgical indication did not receive surgery. We aimed to review the most contemporary practice from June 2014 to December 2018. Only patients who were physically evaluated at our facility were included. Follow up was 100% complete. Kaplan-Meier methods were used to estimate survival and freedom from a composite outcome of death, stroke, and heart failure. Results: Of the 174 patients with surgical indication during the review period, 46 (27%) did not undergo surgery. The reasons for not pursuing surgery were varied and usually multiple, with severe brain injury and end stage liver disease between the most common. The 30-day mortality was 63%, and the estimated survival at 6 months, 1 year, and 2 years was respectively 22%, 15%, and 10%. Conclusion: The mortality of this cohort of patients is extremely high. A multidisciplinary evaluation is of paramount importance in the decision-making process with shared responsibility for denial of operative options. In a perspective of correct healthcare resources allocation an early palliative care consult may need to be considered in some of those patients.

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Section: Discussionmentioning

confidence: 99%

The fate of active left‐side infective endocarditis with operative indication in absence of valve surgery

Carino

Fernández-Cisneros

Hernández‐Meneses

et al. 2020

Journal of Cardiac Surgery

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“…Nonetheless, multiple prior studies have developed calculators for risk stratification in IE 13,14 . An evaluation of these various risk scores found one that was developed using national STS data to be the most predictive with a c‐index of 0.76 15 . This particular risk index was derived in a study of over 19 000 patients with IE in the STS database which identified risk factors for 30‐day mortality, including operative urgency, cardiogenic shock, preoperative renal failure, diabetes, prior cardiac surgery, chronic lung disease, and multiple valve involvement 16 .…”

Section: Discussionmentioning

confidence: 99%

“…13,14 An evaluation of these various risk scores found one that was developed using national STS data to be the most predictive with a c-index of 0.76. 15 This particular risk index was derived in a study of over 19 000 patients with IE in the STS database which identified risk factors for 30-day mortality, including operative urgency, cardiogenic shock, preoperative renal failure, diabetes, prior cardiac surgery, chronic lung disease, and multiple valve involvement. 16 Although their study was designed to identify risk factors for 30-day mortality, many of the risk factors in their score were also identified in our study as predictors of longitudinal mortality risk.…”

Section: Overallmentioning

confidence: 99%

Surgical treatment of infective endocarditis: Results in 831 patients from a single center

et al. 2020

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Introduction This study evaluated surgical outcomes of infective endocarditis (IE), with particular attention to the impact of intravenous drug use (IVDU). Methods Adult patients undergoing surgery for IE between 2011 and 2018 at a single center were included and stratified by IVDU. The primary outcome was overall survival. Secondary outcomes included postoperative complications and hospital readmissions. Kaplan‐Meier and multivariable Cox regression were utilized for unadjusted and risk‐adjusted survival analyses, respectively. Cumulative incidence function curves were compared for hospital readmissions. Results A total of 831 patients (mean age 55 years, 34.4% female) were operated on for IE, including 318 (38.3%) with IVDU. Cultures were most commonly positive for streptococcus (25.2%), methicillin‐sensitive Staphylococcus aureus (17.7%), enterococcus (14.3%), or methicillin‐resistant Staphylococcus aureus (8.4%). The most common procedures included isolated aortic valve repair/replacement (18.8%), aortic root replacement (15.9%), mitral valve repair/replacement (26.7%), aortic and mitral valve replacement (8.4%), and tricuspid valve repair/replacement (7.6%). Mean follow‐up was 3.4 ± 2.4 years. Overall 5‐year survival was 64% and was similar between IVDU and non‐IVDU. Multivariable analysis demonstrated that IVDU was not associated with mortality risk. IVDU patients displayed higher rates of all‐cause readmission (61.6% vs 53.9%; P = .03), drug‐use readmission (15.4% vs 1.4%; P < .001), and recurrent endocarditis readmission (33.0% vs 13.0%; P < .001). Conclusions The majority of patients undergoing surgical treatment of IE are alive at 5‐years although readmission rates are high. IVDU is not a risk factor for longitudinal mortality although patients with IVDU are at higher overall readmission risk, driven largely by greater readmissions for drug‐use and recurrent endocarditis.

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“…According to a new study, the origin of the IE episode could be attributed to diagnostic procedures in 10.52% of the cases, to intercurrent infectious processes in 42.11% of the cases, to other surgical procedures in 26.3% of the cases, and to unknown causes in 21.05% of the cases, with the need for surgical treatment in all the cases (29) . The fact that an IE is produced due to any of the aforementioned causes generates a considerable increase in the risk of the bacterial layer settling on the prosthetic materials, or of residual injuries and frequently on right cavities (30) , which becomes a serious form of the disease with high global mortality (29) . Nevertheless, these researchers did not determine the source of the bacteremia, nor did they establish the elements or components of the possible infection focuses, which is necessary to establish a clinical suspicion prior to providing an early diagnosis and treatment to the patients.…”

Section: Methodsmentioning

confidence: 99%

Bacteremia in the red blood cells obtained from the cell saver in patients submitted to heart surgery

Oliveros

2020

Rev. Latino-Am. Enfermagem

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Objective: to determine the microbiological characteristics of the red blood cells obtained with the cell saver in heart surgery patients on an extra-body circuit. Method: a cross-sectional and descriptive study conducted with 358 patients scheduled for heart surgery where the saver was used. Sociodemographic variables were collected, as well as from the saver and of the microbial identification in the re-infusion bag proceeding from the cell saver. Informed consent performed. Results: of the 170 GRAM+ bacteria isolations, the most frequent species were Staphylococcus epidermidis in 69% (n=138) of the cases and Streptococcus sanguinis with a report of 10% (n=20). Significant differences were found in the Staphylococcus epidermidis strain in patients with a Body Mass Index ≥25 (p=0.002) submitted to valve surgery (p=0.001). Vancomycin was the antimicrobial which resisted the Staphylococcus epidermidis strain with a minimum inhibitory concentration of >16 µg/ml. Conclusion: the microbiological characteristics of the red blood cells obtained after processing autologic blood recovered with the cell saver during heart surgery are of GRAM+ bacterial origin, the most isolated species being Staphylococcus epidermidis. Consequently, in order to reduce the presence of these GRAM+ cocci, an antibiotic should be added to the cell saver reservoir, according to a previously established protocol.

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Mortality risk prediction in infective endocarditis surgery: reliability analysis of specific scores†

Cited by 36 publications

References 22 publications

The fate of active left‐side infective endocarditis with operative indication in absence of valve surgery

The fate of active left‐side infective endocarditis with operative indication in absence of valve surgery

Surgical treatment of infective endocarditis: Results in 831 patients from a single center

Bacteremia in the red blood cells obtained from the cell saver in patients submitted to heart surgery

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