Publication details

Association Between Surgical Indications, Operative Risk, and Clinical Outcome in Infective Endocarditis A Prospective Study From the International Collaboration on Endocarditis

Authors	CHU Vivian H. PARK Lawrence P. ATHAN Eugene DELAHAYE Francois FREIBERGER Tomáš LAMAS Cristiane MIRO Jose M. MUDRICK Daniel W. STRAHILEVITZ Jacob TRIBOUILLOY Christophe DURANTE-MANGONI Emanuele PERICAS Juan M. FERNANDEZ-HIDALGO Nuria NACINOVICH Francisco RIZK Hussein KRAJINOVIC Vladimir GIANNITSIOTI Efthymia HURLEY John P. HANNAN Margaret M. WANG Andrew
Year of publication	2015
Type	Article in Periodical
Magazine / Source	Circulation
MU Faculty or unit	Central European Institute of Technology
Citation
Web	http://circ.ahajournals.org/content/131/2/131.full.pdf+html
Doi	http://dx.doi.org/10.1161/CIRCULATIONAHA.114.012461
Field	Cardiovascular diseases incl. cardiosurgery
Keywords	endocarditis; infection; mortality; surgery; valve
Description	Background-Use of surgery for the treatment of infective endocarditis (IE) as related to surgical indications and operative risk for mortality has not been well defined. Methods and Results-The International Collaboration on Endocarditis-PLUS (ICE-PLUS) is a prospective cohort of consecutively enrolled patients with definite IE from 29 centers in 16 countries. We included patients from ICE-PLUS with definite left-sided, non-cardiac device-related IE who were enrolled between September 1, 2008, and December 31, 2012. A total of 1296 patients with left-sided IE were included. Surgical treatment was performed in 57% of the overall cohort and in 76% of patients with a surgical indication. Reasons for nonsurgical treatment included poor prognosis (33.7%), hemodynamic instability (19.8%), death before surgery (23.3%), stroke (22.7%), and sepsis (21%). Among patients with a surgical indication, surgical treatment was independently associated with the presence of severe aortic regurgitation, abscess, embolization before surgical treatment, and transfer from an outside hospital. Variables associated with nonsurgical treatment were a history of moderate/severe liver disease, stroke before surgical decision, and Staphyloccus aureus etiology. The integration of surgical indication, Society of Thoracic Surgeons IE score, and use of surgery was associated with 6-month survival in IE. Conclusions-Surgical decision making in IE is largely consistent with established guidelines, although nearly one quarter of patients with surgical indications do not undergo surgery. Operative risk assessment by Society of Thoracic Surgeons IE score provides prognostic information for survival beyond the operative period. S aureus IE was significantly associated with nonsurgical management.