Risk of reoperative valve surgery for endocarditis associated with drug use

Commentary: How many times are enough? Infective endocarditis in drug users

“…Data were gathered by interrogating each center's Society of Thoracic Surgeons database. Mori and colleagues 4 found that the overall case volume and the proportion of RVS during the study period increased significantly, from 19% to 28%. As expected, patients undergoing RVS have higher operative risk and higher unadjusted 30-day mortality than those undergoing FSV.…”

“…The younger age and lower burden of baseline morbidity among these patients may partly explain the lower mortality (8.1%) among patients with RVS, despite higher markers of surgical acuity, than in previous reports, 5,6 which show a greater than 20% mortality for patients with prosthetic valve IE without a history of DU. Notably, the study by Mori and colleagues 4 does not have a comparator group consisting of patients with IE but without DU. Furthermore, the lower mortality could be explained by the high prevalence of right-sided IE (34%), which is thought to have better prognosis than left-sided IE.…”

“…Furthermore, the lower mortality could be explained by the high prevalence of right-sided IE (34%), which is thought to have better prognosis than left-sided IE. One of the major limitations of the study by Mori and colleagues 4 is the potential for misclassification bias, and, as a result, the data need to be analyzed cautiously. Any history of DU allows the inclusion of patients without intravenous injection DU and those with recreational DU, including the use of cannabinoids, which is common among young patients and has not been shown to be pathophysiologically linked to IE.…”

“…The absence of a clear distinction between a remote and a recent history of DU is also another drawback of the study of Mori and colleagues. 4 A history of recent DU had not been reported in 25% of patients undergoing FVS and 46% of those undergoing RVS, and was limited to patients in later Society of Thoracic Surgeons iterations, which included DU timing information in relation to valvular surgery.…”

Commentary: When is repeated cardiac valve surgery justified during drug-associated infective endocarditis?

“…Mori and colleagues 4 reported on the records of 925 patients from 8 centers with drug-associated infective endocarditis who were analyzed after first-time or repeated cardiac valve surgery. The patients all had drug-associated infective endocarditis by definition, and tricuspid and Staphylococcal valve infections were common.…”