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?

Bannay, A.; Hoën, Bruno; Duval, Xavier; Obadia, Jean‐François; Tattevin, Pierre; Iung, Bernard; Alla, François; Briançon, Serge; Bruneval, P; Danchin, Nicolás; Goulet, V.; Roudaut, Raymond; Salamon, Roger; Texier-Maugein, J; Bernard, Yvette; Duchêne, F.; Plésiat, Patrick; Doco‐Lecompte, T.; Selton‐Suty, Christine; Weber, Michèle; Béguinot, I.; Nazeyrollas, Pierre; Vernet, V.; Garin, Benoît; Lacassin, F.; Robert, J M; Andremont, Antoine; Garbaz, Eric; Moing, Vincent Le; Leport, Catherine; Mainardi, Jean–Luc; Ruimy, Raymond; Chidiac, Christian; Delahaye, François; Boucherit, Soraya; Bourezane, Y.; Nouioua, W.; Renaud, D.L.; Bouvet, Anne; Collobert, Gislène; Merad, B; Schlegel, L.; Bes, M.; Etienne, Jérôme; Vandenesch, François

doi:10.1093/eurheartj/ehp008

Cited by 164 publications

(100 citation statements)

References 31 publications

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“…Po incydencie neurologicznym często pojawiają się lub uzyskują dodatkowe znaczenie wskazania do leczenia operacyjnego, ale kwalifikując chorego do operacji należy wziąć pod uwagę proporcje między ryzykiem przedoperacyjnym a zakładanym rokowaniem pooperacyjnym. Nie jest możliwe prowadzenie badań randomizowanych, a badania kohortowe są obciążone błędami doboru grupy badanej, które tylko w części mogą być zrów-noważone metodami statystycznymi [115,[260][261][262]. Jednak po bezobjawowym zatorze mózgowym lub przemijającym epizodzie niedokrwienia mózgu ryzyko pooperacyjnego pogorszenia stanu neurologicznego jest niskie, dlatego w przypadku utrzymujących się wskazań należy bez opóźnień przeprowadzić zabieg operacyjny [105].…”

Section: Wskazania I Tryb Leczenia Operacyjnego W Celu Zapobiegania Zunclassified

2015 ESC Guidelines for the management of infective endocarditis

Habib¹,

Lancellotti

Antunes³

et al. 2015

Kardiol Pol

144

212

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Section: Wskazania I Tryb Leczenia Operacyjnego W Celu Zapobiegania Zunclassified

2015 ESC Guidelines for the management of infective endocarditis

Habib¹,

Lancellotti

Antunes³

et al. 2015

Kardiol Pol

144

212

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“…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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“…15 However, these studies had substantial biases and lacked methodologic or statistical rigour. Although it is not established Practice that early surgery is superior for all patients, emerging studies suggest that earlier intervention may reduce the occurrence of embolic events and death.…”

Section: Timingmentioning

confidence: 99%

Fever and multiorgan infarcts in a 35-year-old man

Wong

Chugh

Lee

2012

CMAJ

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A previously healthy 35-year-old man was brought to the emergency department by his family because they were concerned that he was confused. He had experienced five days of flu-like symptoms with fever, progressive swelling of his feet and hands, shortness of breath when lying down, and blurred vision. He had no history of valvular or other cardiac disease. There was no known intravenous drug use or dental or invasive procedures.At presentation, he was febrile (38.7°C) and somnolent, but he was hemodynamically stable. He had generalized pitting edema in all extremities. His cardiac examination was normal with no murmurs, and his lungs were clear with no adventitious sounds. There was mild nonspecific abdominal tenderness on palpation. No obvious skin rashes or lesions were observed. Given the presence of fever, bacteremia with Gram-positive cocci and cerebral hemorrhage, there was a high degree of suspicion for bacterial infective endocarditis (c) despite the absence of obvious risk factors. The lack of other systemic manifestations, as well as the presence of bacteremia, pointed away from vasculitis. Although we could not immediately exclude a cerebral abscess based on the preliminary findings, the presence of peripheral edema and orthopnea in the patient's history supported a heart failure syndrome, which is a common complication of infective endocarditis.1 Illicit drug use should be considered in patients who present with rightsided valvular involvement, signs and symptoms of right heart failure, or septic pulmonary emboli or abscesses. In this case, clinical suspicion of intravenous drug use was low.A magnetic resonance angiogram of the patient's head was obtained to further delineate the intracerebral hemorrhage and to rule out abscess and vascular abnormalities. It confirmed the presence of a hematoma (3.4 × 5.0 cm) in the right parieto-occipital lobe and revealed a mycotic aneurysm as the likely cause of the cerebral hemorrhage. Multifocal hemorrhagic infarcts consistent with cerebral embolism were also seen.The patient was transferred to a tertiary care centre for his intracranial hemorrhage to be assessed by a neurosurgeon. A neurosurgical intervention was not thought to be immediately necessary because the hematoma was stable on repeat CT scans, he remained neurologically unchanged, and his perioperative risk was increased by the concomitant severe thrombocytopenia and renal insufficiency.Empirical intravenous vancomycin therapy was started for treatment of suspected infective endocarditis. However, the antimicrobial therapy was changed to cloxacillin for methicillin-sensitive Staphylococcus aureus, which was grown in the first two blood cultures. Subsequent blood cultures obtained after antibiotic therapy was started were negative.The thrombocytopenia and renal failure were believed to be related to septicemia. There was no evidence to suggest glomerulonephritis. He received a platelet transfusion and intravenous immunoglobulin (IVIg) for two days to stabilize his platelet count, while his renal funct...

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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?

Abstract: Previous conflicting results appear to be related to differences in statistical methods. When using appropriate models, we found that VS was significantly associated with reduced long-term mortality.

Cited by 164 publications

References 31 publications

2015 ESC Guidelines for the management of infective endocarditis

2015 ESC Guidelines for the management of infective endocarditis

Infective Endocarditis in Low- and Middle-Income Countries

Fever and multiorgan infarcts in a 35-year-old man

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