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Gros A, Seguy B, Bonnet G, Guettard YO, Pillois X, Prevel R, Orieux A, Ternacle J, Préau S, Lavie-Badie Y, Coupez E, Coudroy R, Marest D, Martins RP, Gruson D, Tourdias T, Boyer A. Critically ill patients with infective endocarditis, neurological complications and indication for cardiac surgery: a multicenter propensity-adjusted study. Ann Intensive Care 2024; 14:21. [PMID: 38305979 PMCID: PMC10837394 DOI: 10.1186/s13613-023-01221-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 11/26/2023] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND The benefit-risk balance and optimal timing of surgery for severe infective endocarditis (IE) with ischemic or hemorrhagic strokes is unknown. The study aim was to compare the neurological outcome between patients receiving surgery or not. METHODS In a prospective register-based multicenter ICU study, patients were included if they met the following criteria: (i) left-sided IE with an indication for heart surgery; (ii) with cerebral complications documented by cerebral imaging before cardiac surgery; (iii) with Sequential Organ Failure Assessment score ≥ 3. Exclusion criteria were isolated right-sided IE, in-hospital acquired IE and patients with cerebral complications only after cardiac surgery. In the primary analysis, the prognostic value of surgery in term of disability at 6 month was assessed by using a propensity score-adjusted logistic regression. RESULTS 192 patients were included including ischemic stroke (74.5%) and hemorrhagic lesion (15.6%): 67 (35%) had medical treatment and 125 (65%) cardiac surgery. In the propensity score-adjusted logistic regression, a favorable 6-month neurological outcome was associated with surgery (odds ratio 13.8 (95% CI 6.2-33.7). The 1-year mortality was strongly reduced with surgery in the fixed-effect propensity-adjusted Cox model (hazard ratio 0.18; 95% CI 0.11-0.27; p < 0.001). These effects remained whether the patients received delayed surgery (n = 62/125) or not and whether they were deeply comatose (Glasgow Coma Scale ≤ 10) or not. CONCLUSIONS In critically ill IE patients with an indication for surgery and previous cerebral events, a better propensity-adjusted neurological outcome was associated with surgery compared with medical treatment.
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Affiliation(s)
- Alexandre Gros
- Service de Médecine Intensive Réanimation, CHU de Bordeaux, 33000, Bordeaux, France
| | - Benjamin Seguy
- Soins Intensifs de Cardiologie, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, 33000, Pessac cedex, France
| | - Guillaume Bonnet
- Soins Intensifs de Cardiologie, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, 33000, Pessac cedex, France
| | | | - Xavier Pillois
- Hôpital Cardiologique du Haut-Lévêque, LIRYC Institute, 33000, Bordeaux, France
| | - Renaud Prevel
- Service de Médecine Intensive Réanimation, CHU de Bordeaux, 33000, Bordeaux, France
| | - Arthur Orieux
- Service de Médecine Intensive Réanimation, CHU de Bordeaux, 33000, Bordeaux, France
| | - Julien Ternacle
- Soins Intensifs de Cardiologie, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, 33000, Pessac cedex, France
| | - Sebastien Préau
- Service de Médecine Intensive Réanimation, Inserm, Institut Pasteur de Lille, U1167, University of Lille, CHU Lille, 59000, Lille, France
| | - Yoan Lavie-Badie
- Fédération de Cardiologie, Centre Expert de la Valve, CHU de Toulouse, 31000, Toulouse, France
| | - Elisabeth Coupez
- Réanimation Médicale Polyvalente, CHU de Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Rémi Coudroy
- Médecine Intensive Réanimation, CHU de Poitiers, F-86000, Poitiers, France
- Groupe ALIVE, INSERM CIC 1402, Université de Poitiers, F-86000, Poitiers, France
| | - Delphine Marest
- Service d'Anesthésie-Réanimation, Hôpital Laënnec, CHU de Nantes, 44000, Nantes, France
| | - Raphaël P Martins
- Cardiologie et Maladies Vasculaires, CHU de Rennes, 35000, Rennes, France
| | - Didier Gruson
- Service de Médecine Intensive Réanimation, CHU de Bordeaux, 33000, Bordeaux, France
| | - Thomas Tourdias
- Service de Neuroradiologie, CHU de Bordeaux, 33000, Bordeaux, France
- INSERM-U1215, Neurocentre Magendie, 33000, Bordeaux, France
| | - Alexandre Boyer
- Service de Médecine Intensive Réanimation, CHU de Bordeaux, 33000, Bordeaux, France.
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Fernández-Ruiz M, Aguado JM. Which trial do we need? Elective early surgical treatment of left-sided infective endocarditis. Clin Microbiol Infect 2023; 29:1103-1106. [PMID: 37061092 DOI: 10.1016/j.cmi.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 04/02/2023] [Accepted: 04/07/2023] [Indexed: 04/17/2023]
Affiliation(s)
- Mario Fernández-Ruiz
- Unit of Infectious Diseases, Hospital Universitario '12 de Octubre', Instituto de Investigación Sanitaria Hospital '12 de Octubre' (imas12), Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain; Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
| | - José María Aguado
- Unit of Infectious Diseases, Hospital Universitario '12 de Octubre', Instituto de Investigación Sanitaria Hospital '12 de Octubre' (imas12), Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain; Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain.
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Peláez Ballesta AI, García Vázquez E, Gómez Gómez J. Infective endocarditis treated in a secondary hospital: epidemiological, clinical, microbiological characteristics and prognosis, with special reference to patients transferred to a third level hospital. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2022; 35:35-42. [PMID: 34845895 PMCID: PMC8790653 DOI: 10.37201/req/092.2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 09/08/2021] [Accepted: 10/14/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To analyse the clinical and epidemiological characteristics and mortality-related factors of patients admitted to a secondary hospital with Infective Endocarditis (IE). METHODS Observational study of a cohort of patients who have been diagnosed with IE in a secondary hospital and evaluated in accordance with a pre-established protocol. RESULTS A total of 101 cases were evaluated (years 2000-2017), with an average age of 64 years and a male-to-female ratio of 2:1. 76% of the cases had an age-adjusted Charlson comorbidity index of >6, with 21% having had a dental procedure and 36% with a history of heart valve disease. The most common microorganism was methicillin-susceptible S. aureus (36%), with bacterial focus of unknown origin in 54%. The diagnostic delay time was 12 days in patients who were transferred, compared to 8 days in patients who were not transferred (p=0.07); the median surgery indication delay time was 5 days (IQR 13.5). The in-hospital mortality rate was 34.6% and the prognostic factors independently associated with mortality were: cerebrovascular events (OR 98.7%, 95% CI, 70.9-164.4); heart failure (OR 27.3, 95% CI, 10.2-149.1); and unsuitable antibiotic treatment (OR 7.2, 95% CI, 1.5-10.5). The mortality rate of the patients who were transferred and who therefore underwent surgery was 20% (5/25). CONCLUSIONS The onset of cerebrovascular events, heart failure and unsuitable antibiotic treatment are independently and significantly associated with in-hospital mortality. The mortality rate was higher than the published average (35%); the diagnostic delay was greater in patients for whom surgery was indicated.
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Affiliation(s)
- A I Peláez Ballesta
- Ana Isabel Peláez Ballesta, Internal Medicine Department of the Hospital General Universitario Rafael Méndez (Lorca). Spain.
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4
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Cecchi E, Ciccone G, Chirillo F, Imazio M, Cecconi M, Del Ponte S, Moreo A, Faggiano P, Cialfi A, Squeri A, Enia F, Forno D, De Rosa FG, Rinaldi M, Castiglione A. Mortality and timing of surgery in the left-sided infective endocarditis: an Italian multicentre study. Interact Cardiovasc Thorac Surg 2019; 26:602-609. [PMID: 29272391 DOI: 10.1093/icvts/ivx394] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 11/18/2017] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Observational studies on early surgery in infective endocarditis have conflicting results. This study aims to compare the treatment strategies for early surgery (within 2 weeks of diagnosis) and late surgery/medical therapy in terms of survival among patients with the left-sided infective endocarditis. METHODS This study included patients with the left-sided infective endocarditis registered between 2006 and 2010 in the Italian Registry of Infective Endocarditis (RIEI). A Cox proportional hazards model was used to estimate the effect of these treatment strategies on overall survival and included sociodemographic and clinical characteristics associated with treatment, risk factors for mortality and early surgery as a time-dependent covariate to avoid indication and immortal time biases. RESULTS Among the 502 patients included, 184 (36.7%) underwent early surgery. Of the remaining 318 patients, 138 underwent late surgery. The early surgery group had fewer patients with comorbidities and with enterococcus as the causative microorganism, but this group had more complicated cardiac conditions. No difference in mortality risk was estimated between the treatment groups including early surgery as time-dependent variables (adjusted hazard ratio = 0.95, 95% confidence interval 0.55-1.63), while a distorted and overestimated beneficial effect of surgery was estimated considering surgery as a non-time-dependent variable (adjusted hazard ratio 0.41, 95% confidence interval 0.25-0.70). CONCLUSIONS Our study did not confirm a better overall survival in patients undergoing early surgery. However, even with the use of statistical techniques to control biases, we could not draw definitive conclusions that early surgery is not beneficial. Our results need to be assessed by randomized trials before any changes in clinical practice can be recommended.
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Affiliation(s)
- Enrico Cecchi
- Department of Cardiology, Maria Vittoria Hospital, Torino, Italy
| | - Giovannino Ciccone
- Unit of Clinical Epidemiology, Città della Salute e della Scienza di Torino and CPO Piemonte, Torino, Italy
| | - Fabio Chirillo
- Department of Cardiology, Ca' Foncello Hospital, Treviso, Italy
| | - Massimo Imazio
- Department of Cardiology, Maria Vittoria Hospital, Torino, Italy
| | - Moreno Cecconi
- Dipartimento di Scienze Cardiologiche Mediche e Chirurgiche Azienda, Ospedaliera Universitaria, Ospedali Riuniti, Ancona, Italy
| | | | - Antonella Moreo
- Department of Cardiology, Niguarda Ca' Granda Hospital, Milano, Italy
| | | | | | - Angelo Squeri
- Dipartimento Cardio, Nefro-Polmonare, Azienda Ospedaliera-Universitaria di Parma, Parma, Italy
| | - Francesco Enia
- Department of Cardiology, Cervello Hospital, Palermo, Italy
| | - Davide Forno
- Department of Cardiology, Maria Vittoria Hospital, Torino, Italy
| | - Francesco Giuseppe De Rosa
- Department of Medical Sciences, University of Turin; Infectious Diseases at Amedeo di Savoia Hospital, Turin, Italy
| | - Mauro Rinaldi
- Department of Cardiac Surgery, Molinette Hospital, University of Torino, Torino, Italy
| | - Anna Castiglione
- Unit of Clinical Epidemiology, Città della Salute e della Scienza di Torino and CPO Piemonte, Torino, Italy
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Ramos-Martínez A, Muñoz Serrano A, de Alarcón González A, Muñoz P, Fernández-Cruz A, Valerio M, Fariñas MC, Gutiérrez-Cuadra M, Miró JM, Ruiz-Morales J, Sousa-Regueiro D, Montejo JM, Gálvez-Acebal J, HidalgoTenorio C, Domínguez F. Gentamicin may have no effect on mortality of staphylococcal prosthetic valve endocarditis. J Infect Chemother 2018; 24:555-562. [PMID: 29628387 DOI: 10.1016/j.jiac.2018.03.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 01/23/2018] [Accepted: 03/06/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE To analyze the influence of adding gentamicin to a regimen consisting of β-lactam or vancomycin plus rifampicin on survival in patients suffering from Staphylococcal prosthetic valve endocarditis (SPVE). METHODS From January 2008 to September 2016, 334 patients with definite SPVE were attended in the participating hospitals. Ninety-four patients (28.1%) received treatment based on β-lactam or vancomycin plus rifampicin and were included in the study. Variables were analyzed which related to patient survival during admission, including having received treatment with gentamicin. RESULTS Seventy-seven (81.9%) were treated with cloxacillin (or vancomycin) plus rifampicin plus gentamicin, and 17 patients (18.1%) received the same regimen without gentamicin. The causative microorganism was Staphylococcus aureus in 40 cases (42.6%) and coagulase-negative staphylococci in 54 cases (57.4%). Overall, 40 patients (42.6%) died during hospital admission, 33 patients (42.9%) in the group receiving gentamicin and 7 patients in the group that did not (41.2%, P = 0.899). Worsening renal function was observed in 42 patients (54.5%) who received gentamicin and in 9 patients (52.9%) who did not (p = 0.904). Heart failure as a complication of endocarditis (OR: 4.58; CI 95%: 1.84-11.42) and not performing surgery when indicated (OR: 2.68; CI 95%: 1.03-6.94) increased mortality. Gentamicin administration remained unrelated to mortality (OR: 1.001; CI 95%: 0.29-3.38) in the multivariable analysis. CONCLUSIONS The addition of gentamicin to a regimen containing vancomycin or cloxacillin plus rifampicin in SPVE was not associated to better outcome.
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Affiliation(s)
- Antonio Ramos-Martínez
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Universitario Puerta de Hierro, Majadahonda, Universidad Autónoma de Madrid, Madrid, Spain.
| | - Alejandro Muñoz Serrano
- Servicio de Medicina Interna, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
| | - Arístides de Alarcón González
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Grupo de Investigación sobre Enfermedades Infecciosas, Instituto de Biomedicina de Sevilla (IBIS), Universidad de Sevilla / CSIC / Universidad Virgen del Rocío y Virgen Macarena, Sevilla, Spain.
| | - Patricia Muñoz
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Facultad de Medicina, Universidad Complutense de Madrid, Spain.
| | - Ana Fernández-Cruz
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
| | - Maricela Valerio
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
| | - María Carmen Fariñas
- Unidad de Enfermedades Infecciosas Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Spain.
| | - Manuel Gutiérrez-Cuadra
- Unidad de Enfermedades Infecciosas Hospital Universitario Marqués de Valdecilla, Santander, Spain.
| | - José Ma Miró
- Servicio de Enfermedades Infecciosas, Hospital Clinic-IDIBAPS. Universidad de Barcelona, Barcelona, Spain.
| | - Josefa Ruiz-Morales
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Hospital Clínico Universitario Virgen de la Victoria, IBIMA, Málaga, Spain.
| | | | - José Miguel Montejo
- Unidad de Enfermedades Infecciosas, Hospital Universitario de Cruces, Bilbao, Universidad del País Vasco, País Vasco, Spain.
| | - Juan Gálvez-Acebal
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena Instituto de Biomedicina de Sevilla, IBIS. Universidad de Sevilla, Sevilla, Spain.
| | - Carmen HidalgoTenorio
- Servicio de Enfermedades Infecciosas, Hospital Universitario Virgen de las Nieves, Complejo Hospitalario de Granada, Granada, Spain.
| | - Fernando Domínguez
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
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Fernández-Hidalgo N, Almirante B. Current status of infectious endocarditis: New populations at risk, new diagnostic and therapeutic challenges. Enferm Infecc Microbiol Clin 2018; 36:69-71. [PMID: 29325999 DOI: 10.1016/j.eimc.2017.11.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 11/30/2017] [Indexed: 01/22/2023]
Affiliation(s)
| | - Benito Almirante
- Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron, Barcelona, España
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Tepsuwan T, Rimsukcharoenchai C, Tantraworasin A, Woragidpoonpol S, Schuarattanapong S, Nawarawong W. Is delayed surgery related to worse outcomes in native left-sided endocarditis? Asian Cardiovasc Thorac Ann 2016; 24:309-15. [DOI: 10.1177/0218492316637714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Background Timing of surgery in the management of infective endocarditis is controversial, and there is still no definite conclusion on how early the surgery should be performed. This study focuses on the outcomes of surgery during the active period of infective endocarditis in consideration of the duration after diagnosis. Methods One hundred and thirty-four patients with active native valve infective endocarditis who underwent surgery from January 2006 to December 2013 were reviewed retrospectively. They were divided in 2 groups based on timing of surgery: early group (first week after diagnosis, n = 37) and delayed group (2 to 6 weeks after diagnosis, n = 97). Results Compared to the delayed group, the early group had significantly more patients in New York Heart Association class IV (81% vs. 43.3%), more mechanically ventilated (54.1% vs. 18.6%), more on inotropic support (62.2% vs. 38.1%), and hence a worse EuroSCORE II (14.8% vs. 8.8%). Operative mortality was comparable (5.4% vs. 10.3%) and 7-year survival was similar (77.4% vs. 74.6%). On multivariable regression analysis, delayed surgery did not impact on short- and long-term outcomes. Preoperative cardiac arrest and infection with Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, or Kingella were risk factors for higher operative mortality. Predictors of poor 7-year survival were diabetes mellitus and acute renal failure. Conclusions 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.
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Affiliation(s)
- Thitipong Tepsuwan
- Cardiothoracic Division, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Chartaroon Rimsukcharoenchai
- Cardiothoracic Division, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Apichat Tantraworasin
- Cardiothoracic Division, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Surin Woragidpoonpol
- Cardiothoracic Division, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Suphachai Schuarattanapong
- Cardiothoracic Division, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Weerachai Nawarawong
- Cardiothoracic Division, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Liang F, Song B, Liu R, Yang L, Tang H, Li Y. Optimal timing for early surgery in infective endocarditis: a meta-analysis. Interact Cardiovasc Thorac Surg 2015; 22:336-45. [PMID: 26678152 DOI: 10.1093/icvts/ivv368] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 11/19/2015] [Indexed: 12/20/2022] Open
Abstract
To systematically review early surgery and the optimal timing of surgery in patients with infective endocarditis (IE), a search for foreign and domestic articles on cohort studies about the association between early surgery and infective endocarditis published from inception to January 2015 was conducted in the PubMed, EMBASE, Chinese Biomedical Literature (CBM), Wanfang and Chinese National Knowledge Infrastructure (CNKI) databases. The studies were screened according to the inclusion and exclusion criteria, the data were extracted and the quality of the method of the included studies was assessed. Then, the meta-analysis was performed using the Stata 12.0 software. Sixteen cohort studies, including 8141 participants were finally included. The results of the meta-analysis revealed that, compared with non-early surgery, early surgery in IE lowers the incidence of in-hospital mortality [odds ratio (OR) = 0.57, 95% confidence interval (CI) (0.42, 0.77); P = 0.000, I(2) = 73.1%] and long-term mortality [OR = 0.57, 95% CI (0.43, 0.77); P = 0.001, I(2) = 67.4%]. Further, performing operation within 2 weeks had a more favourable effect on long-term mortality [OR = 0.63, 95% CI (0.41, 0.97); P = 0.192, I(2) = 39.4%] than non-early surgery. In different kinds of IE, we found that early surgery for native valve endocarditis (NVE) had a lower in-hospital [OR = 0.46, 95% CI (0.31, 0.69); P = 0.001, I(2) = 73.0%] and long-term [OR = 0.57, 95% CI (0.40, 0.81); P = 0.001, I(2) = 68.9%] mortality than the non-early surgery group. However, for prosthetic valve endocarditis (PVE), in-hospital mortality did not differ significantly [OR = 0.83, 95% CI (0.65, 1.06); P = 0.413, I(2) = 0.0%] between early and non-early surgery. We concluded that early surgery was associated with lower in-hospital and long-term mortality compared with non-early surgical treatment for IE, especially in NVE. However, the optimal timing of surgery remains unclear. Additional larger prospective clinical trials will be required to clarify the optimal timing for surgical intervention and determine its efficacy in PVE.
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Affiliation(s)
- Fuxiang Liang
- The First Clinical College of Lanzhou University, Lanzhou University, Lanzhou, China Department of Cardiovascular Surgery, The First Hospital of Lanzhou University, Lanzhou University, Lanzhou, China
| | - Bing Song
- The First Clinical College of Lanzhou University, Lanzhou University, Lanzhou, China Department of Cardiovascular Surgery, The First Hospital of Lanzhou University, Lanzhou University, Lanzhou, China
| | - Ruisheng Liu
- The First Clinical College of Lanzhou University, Lanzhou University, Lanzhou, China Department of Cardiovascular Surgery, The First Hospital of Lanzhou University, Lanzhou University, Lanzhou, China
| | - Liu Yang
- Department of Cardiovascular Surgery, The First Hospital of Lanzhou University, Lanzhou University, Lanzhou, China
| | - Hanbo Tang
- The First Clinical College of Lanzhou University, Lanzhou University, Lanzhou, China Department of Cardiovascular Surgery, The First Hospital of Lanzhou University, Lanzhou University, Lanzhou, China
| | - Yuanming Li
- The First Clinical College of Lanzhou University, Lanzhou University, Lanzhou, China Department of Cardiovascular Surgery, The First Hospital of Lanzhou University, Lanzhou University, Lanzhou, China
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Ortiz C, López J, García H, Sevilla T, Revilla A, Vilacosta I, Sarriá C, Olmos C, Ferrera C, García PE, Sáez C, Gómez I, San Román JA. Clinical classification and prognosis of isolated right-sided infective endocarditis. Medicine (Baltimore) 2014; 93:e137. [PMID: 25501052 PMCID: PMC4602814 DOI: 10.1097/md.0000000000000137] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
From an epidemiologic point of view, right-sided infective endocarditis (RSIE) affects different types of patients: intravenous drug users (IDUs), cardiac device carriers (pacemakers and implantable automatic defibrillators), and the "3 noes" endocarditis group: no left-sided, no IDUs, no cardiac devices. Our objective is to describe and compare the clinical profile and outcome of these groups of patients. Every episode of infective endocarditis (IE) consecutively diagnosed in 3 tertiary centers from 1996 to 2012 was included in an ongoing multipurpose database. We assessed 85 epidemiologic, clinical, echocardiographic, and outcome variables in patients with isolated RSIE. A bivariated comparative analysis between the 3 groups was conducted.Among 866 IE episodes, 121 were classified as isolated RSIE (14%): 36 IDUs (30%), 65 cardiac device carriers (54%), and 20 "3 noes" group (16%). IDUs were mainly young men (36 ± 7 years) without previous heart disease, few comorbidities, and frequent previous endocarditis episodes (28%). Human immunodeficiency virus infection was frequent (69%). Cardiac device carriers were older (66 ± 15 years) and had less comorbidities (34%). Removal of the infected device was performed in 91% of the patients without any death. The "3 noes" endocarditis group was composed mainly by middle-age men (56 ± 18 years), health care related infections (50%), and had many comorbidities (75%). Whereas Staphylococcus aureus were the most frequent cause in IDUs (72% vs 34% in device carriers and 34% in the "3 noes" group, P = 0.001), coagulase negative Staphylococci predominated in the device carriers (58% vs 11% in drug users and 35% in the "3 noes", P < 0.001). Significant differences in mortality were found (17% in drug users, 3% in device carriers, and 30% in the "3 noes" group; P < 0.001). These results suggest that RSIE should be separated into 3 groups (IDUs, cardiac device carriers, and the "3 noes") and considered as independent entities as there are relevant epidemiologic, clinical, microbiological, echocardiographic, and prognostic differences among them.
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Affiliation(s)
- Carlos Ortiz
- From the Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario, Valladolid (CO, JL, HG, TS, AR, PEG, IG, JASR); Hospital Clínico Universitario San Carlos (IV, CO, CF); and Servicio de Medicina Interna-Infecciosas, Instituto de Investigación del Hospital La Princesa, Madrid, Spain (CS, CS)
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Chirouze C, Alla F, Fowler VG, Sexton DJ, Corey GR, Chu VH, Wang A, Erpelding ML, Durante-Mangoni E, Fernández-Hidalgo N, Giannitsioti E, Hannan MM, Lejko-Zupanc T, Miró JM, Muñoz P, Murdoch DR, Tattevin P, Tribouilloy C, Hoen B. Impact of early valve surgery on outcome of Staphylococcus aureus prosthetic valve infective endocarditis: analysis in the International Collaboration of Endocarditis-Prospective Cohort Study. Clin Infect Dis 2014; 60:741-9. [PMID: 25389255 DOI: 10.1093/cid/ciu871] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The impact of early valve surgery (EVS) on the outcome of Staphylococcus aureus (SA) prosthetic valve infective endocarditis (PVIE) is unresolved. The objective of this study was to evaluate the association between EVS, performed within the first 60 days of hospitalization, and outcome of SA PVIE within the International Collaboration on Endocarditis-Prospective Cohort Study. METHODS Participants were enrolled between June 2000 and December 2006. Cox proportional hazards modeling that included surgery as a time-dependent covariate and propensity adjustment for likelihood to receive cardiac surgery was used to evaluate the impact of EVS and 1-year all-cause mortality on patients with definite left-sided S. aureus PVIE and no history of injection drug use. RESULTS EVS was performed in 74 of the 168 (44.3%) patients. One-year mortality was significantly higher among patients with S. aureus PVIE than in patients with non-S. aureus PVIE (48.2% vs 32.9%; P = .003). Staphylococcus aureus PVIE patients who underwent EVS had a significantly lower 1-year mortality rate (33.8% vs 59.1%; P = .001). In multivariate, propensity-adjusted models, EVS was not associated with 1-year mortality (risk ratio, 0.67 [95% confidence interval, .39-1.15]; P = .15). CONCLUSIONS In this prospective, multinational cohort of patients with S. aureus PVIE, EVS was not associated with reduced 1-year mortality. The decision to pursue EVS should be individualized for each patient, based upon infection-specific characteristics rather than solely upon the microbiology of the infection causing PVIE.
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Affiliation(s)
- Catherine Chirouze
- UMR CNRS 6249 Chrono-Environnement, Université de Franche-Comté Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Régional Universitaire, Besançon
| | - François Alla
- Université de Lorraine, Université Paris Descartes, Apemac, EA4360 INSERM, CIC-EC, CIE6 CHU Nancy, Pôle S2R, Epidémiologie et Evaluation Cliniques, Nancy, France
| | - Vance G Fowler
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Daniel J Sexton
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - G Ralph Corey
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Vivian H Chu
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Andrew Wang
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Marie-Line Erpelding
- INSERM, CIC-EC, CIE6 CHU Nancy, Pôle S2R, Epidémiologie et Evaluation Cliniques, Nancy, France
| | | | - Nuria Fernández-Hidalgo
- Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Efthymia Giannitsioti
- Fourth Department of Internal Medicine, Attikon University General Hospital, Athens, Greece
| | - Margaret M Hannan
- Department of Microbiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - José M Miró
- Hospital Clinic-IDIBAPS, University of Barcelona
| | - Patricia Muñoz
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - David R Murdoch
- Microbiology Unit, Canterbury Health Laboratories, Christchurch, New Zealand
| | - Pierre Tattevin
- Maladies Infectieuses et Réanimation Médicale, Pontchaillou University Hospital, Rennes
| | | | - Bruno Hoen
- UMR CNRS 6249 Chrono-Environnement, Université de Franche-Comté Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Régional Universitaire, Besançon Université des Antilles et de la Guyane, Faculté de Médecine Hyacinthe Bastaraud, EA 4537, Pointe-à-Pitre, Guadeloupe Service de Maladies Infectieuses et Tropicales, CIC 1424, Centre Hospitalier Universitaire, Pointe-à-Pitre, France
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Fernández-Hidalgo N, Tornos Mas P. Epidemiología de la endocarditis infecciosa en España en los últimos 20 años. Rev Esp Cardiol 2013. [DOI: 10.1016/j.recesp.2013.05.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Epidemiology of infective endocarditis in Spain in the last 20 years. ACTA ACUST UNITED AC 2013; 66:728-33. [PMID: 24773679 DOI: 10.1016/j.rec.2013.05.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 05/01/2013] [Indexed: 12/16/2022]
Abstract
Infective endocarditis is an uncommon disease, with an estimated incidence of 3.1 to 3.7 episodes per 100 000 inhabitants/year. The incidence is highest in elderly people. The microorganisms most frequently isolated in infective endocarditis are staphylococci and streptococci. In the last few decades, the spectrum of heart diseases predisposing to infective endocarditis has changed, since degenerative heart disease is the most common valve disease, and there are an increasing number of infective endocarditis patients without previously known valve disease. In addition, up to one-third of infective endocarditis patients become infected through contact with the health system. These patients are more frail, which leads to higher in-hospital mortality. As a result of substantial epidemiological changes, few cases of infective endocarditis can be prevented by antibiotic prophylaxis. Despite advances in medical and surgical treatment, in-hospital mortality among infective endocarditis patients is high. Nevertheless, there is room for improvement in reducing the rate of nosocomial bacteremia, the prompt diagnosis of infective endocarditis in at-risk patients, and the early identification of patients with a highest risk of complications, as well as in the creation of multidisciplinary teams for the management of this disease.
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García-Alonso CJ, Ferrer E, Vallejo N, Delgado L, Pedro-Botet ML, Ruyra X, Bayés-Genis A. [Mitral valve repair in the course of active infectious endocarditis. Study of four patients]. Med Clin (Barc) 2013; 140:504-7. [PMID: 23510612 DOI: 10.1016/j.medcli.2012.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 12/05/2012] [Accepted: 12/13/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND OBJECTIVE Mitral valve (MV) repair is the preferred surgical treatment for degenerative mitral regurgitation (MR). However, questions remain about the efficacy of MV repair when performed for MR caused by infective endocarditis (IE), particularly during its active phase. Although several observational studies have suggested the superiority of MV repair over replacement in patients undergoing surgery for IE, many centres are still opting for valve replacement because of its technical feasibility and reproducibility. In the following document we expose the experience of our hospital. PATIENTS AND METHOD We present a series of 4 patients who recently underwent surgery for IE during its active phase. Epidemiological and clinical characteristics are discussed. RESULTS All patients underwent different MV repair techniques. No relapse or reinfection has been reported. All patients present MR grades 0 or iI/ivIV at follow up. CONCLUSIONS Even during the active phase of IE, MV repair is a feasible technique with good postoperatory results.
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Affiliation(s)
- Carlos J García-Alonso
- Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España.
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Importancia clínica de la insuficiencia cardiaca congestiva en la endocarditis protésica. Estudio multicéntrico de 257 pacientes. Rev Esp Cardiol 2013. [DOI: 10.1016/j.recesp.2012.10.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Clinical significance of congestive heart failure in prosthetic valve endocarditis. A multicenter study with 257 patients. ACTA ACUST UNITED AC 2013; 66:384-90. [PMID: 24775821 DOI: 10.1016/j.rec.2012.10.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Accepted: 10/12/2012] [Indexed: 01/04/2023]
Abstract
INTRODUCTION AND OBJECTIVES There have been no studies conducted in the past that focus on the significance of congestive heart failure in patients with prosthetic valve endocarditis. We studied the incidence of congestive heart failure in patients with prosthetic valve endocarditis and analyzed its profile. In this study, we addressed the prognostic significance of heart failure in patients with prosthetic valve endocarditis and analyzed its outcome based on chosen therapeutic strategies. METHODS A total of 639 episodes of definite left-sided endocarditis were prospectively enrolled. Of them, 257 were prosthetic. Of the 257 episodes, 145 (56%) were diagnosed with heart failure. We compared the profiles of patients with prosthetic valve endocarditis based on the presence of heart failure, and performed a multivariate logistic regression model to establish the prognostic significance of heart failure in patients with prosthetic valve endocarditis and identified the prognostic factors of in-hospital mortality in these patients. RESULTS Persistent infection (odds ratio=3.6; 95% confidence interval, 1.9-6.9) and heart failure (odds ratio=3; 95% confidence interval, 1.5-5.8) are the strongest predictive factors of in-hospital mortality in patients with prosthetic valve endocarditis. The short-term determinants of prognosis in patients with prosthetic valve endocarditis and heart failure are persistent infection (odds ratio=2.8; 95% confidence interval, 1.2-6.5), aortic involvement (odds ratio=2.5; 95% confidence interval, 1.1-5.8), abscess (odds ratio=3.6; 95% confidence interval, 1.4-9.5), diabetes mellitus (odds ratio=2.9; 95% confidence interval, 1.1-7.7), and cardiac surgery (odds ratio=0.2; 95% confidence interval, 0.1-0.5). CONCLUSIONS The incidence of heart failure in patients with prosthetic valve endocarditis is very high. Heart failure increases the risk of in-hospital mortality by threefold in patients with prosthetic valve endocarditis. Persistent infection, aortic involvement, abscess, and diabetes mellitus are the independent risk factors associated with mortality in patients with prosthetic valve endocarditis and heart failure; however, cardiac surgery is shown to decrease mortality in these patients.
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Haider K, Pinsky MR. Early surgery for native valve infective endocarditis. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2013; 17:304. [PMID: 23425501 PMCID: PMC4057157 DOI: 10.1186/cc12497] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Expanded abstract
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Fernández-Hidalgo N, Almirante B, Tornos P, González-Alujas MT, Planes AM, Galiñanes M, Pahissa A. Immediate and long-term outcome of left-sided infective endocarditis. A 12-year prospective study from a contemporary cohort in a referral hospital. Clin Microbiol Infect 2012; 18:E522-30. [PMID: 23077981 DOI: 10.1111/1469-0691.12033] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The aim of this study was to describe the immediate and long-term prognosis of a contemporary cohort of patients with left-sided infective endocarditis (LSIE). A prospective observational cohort study was conducted in a referral centre. Between January 2000 and December 2011, all consecutive adult patients with LSIE were followed-up until death, relapse, recurrence, need for late surgery, or last control. During the active phase of IE, 174 of 438 patients underwent surgery (40% overall; 43% native valve (NVIE), 30% prosthetic valve (PVIE)) and 125 died (29% overall; 26% NVIE, 39% PVIE). The median follow-up in survivors was 3.2 years (interquartile range (IQR) 1.0-6.0 years). Relapses occurred in seven patients (2.2%; 95% CI, 1.1-4.5) and recurrences in eight (2.6%; 95% CI, 1.3-5.0), with an incidence density of 0.0067 per patient-year (95% CI, 0.0029-0.0133) and high mortality (75% of recurrences). Only four of 130 survivors (3.1%; 95% CI, 1.2-7.6) who were treated surgically during the active phase of the disease, and 14/183 (7.7%; 95% CI, 4.6-12.4) of those not undergoing surgery needed operation during follow-up (p 0.09). In the 313 survivors, actuarial survival was 86% at 1 year (87% NVIE, 83% PVIE), 79% at 2 years (81% NVIE, 72% PVIE) and 68% at 5 years (71% NVIE, 57% PVIE). At 1 year, 115 of 397 patients (29.0%; 95% CI, 24.7-33.6) remained alive, with no surgery requirement, relapse or recurrence. LSIE is associated with considerable in-hospital and long-term mortality, especially PVIE. However, relapses, recurrences and the need for late surgery are uncommon.
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Affiliation(s)
- N Fernández-Hidalgo
- Department of Infectious Diseases, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
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[Infective endocarditis in the XXI century: epidemiological, therapeutic, and prognosis changes]. Enferm Infecc Microbiol Clin 2012; 30:394-406. [PMID: 22222058 DOI: 10.1016/j.eimc.2011.11.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Accepted: 11/03/2011] [Indexed: 12/15/2022]
Abstract
Infective endocarditis (IE) is an uncommon and severe disease. Nowadays, in developed countries, IE patients are older, usually have a degenerative heart valve disease, and up to 30% acquire this infection within the health care system. In consequence, staphylococci species are the most frequently isolated microorganisms. Antimicrobial treatment for IE has significantly changed over the last decades. In IE episodes due to Staphylococcus aureus, cloxacillin-resistance makes antimicrobial election more difficult. Other microorganisms, such as enterococci and some species of streptococci, show high rates of resistance to antimicrobial agents established in guidelines. Despite improvements in the diagnosis, and medical and surgical treatment of IE, this disease continues to be associated with high rates of in-hospital mortality. At present, due to epidemiological changes, antimicrobial prophylaxis can avoid few cases of IE. Prevention of nosocomial bacteremia, an early diagnosis of IE, prompt identification of IE patients at a higher risk of mortality, and a multidisciplinary approach of this disease could be valid strategies in order to improve the outcome of these patients.
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Evans CF, Gammie JS. Surgical Management of Mitral Valve Infective Endocarditis. Semin Thorac Cardiovasc Surg 2011; 23:232-40. [DOI: 10.1053/j.semtcvs.2011.07.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2011] [Indexed: 12/11/2022]
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Abstract
The evaluation of valvular and nonvalvular structures is of central importance in the diagnosis, management, and treatment of infective endocarditis (IE). The incidence of IE has remained constant due to changing substrate, with notably higher prevalence observed in the elderly. Mortality and morbidity continue to remain high, despite advances in medical and surgical treatment. This article reviews the technical and practical aspects of the use of echocardiography to evaluate patients with suspected IE.
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Affiliation(s)
- Asimul Ansari
- Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, 676 North Saint Clair Street, Suite 600, Chicago, IL 60611-2981, USA.
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Mestres CA, Miró JM. Invited commentary. Ann Thorac Surg 2011; 91:1413. [PMID: 21524450 DOI: 10.1016/j.athoracsur.2011.02.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2011] [Revised: 02/20/2011] [Accepted: 02/22/2011] [Indexed: 10/18/2022]
Affiliation(s)
- Carlos-A Mestres
- Department of Cardiovascular Surgery, Hospital Clinico-Institut d'Investigacions Biomèdiques, August Pi i Sunyer, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain.
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Head SJ, Mokhles MM, Osnabrugge RLJ, Bogers AJJC, Kappetein AP. Surgery in current therapy for infective endocarditis. Vasc Health Risk Manag 2011; 7:255-63. [PMID: 21603594 PMCID: PMC3096505 DOI: 10.2147/vhrm.s19377] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Indexed: 12/30/2022] Open
Abstract
The introduction of the Duke criteria and transesophageal echocardiography has improved early recognition of infective endocarditis but patients are still at high risk for severe morbidity or death. Whether an exclusively antibiotic regimen is superior to surgical intervention is subject to ongoing debate. Current guidelines indicate when surgery is the preferred treatment, but decisions are often based on physician preferences. Surgery has shown to decrease the risk of short-term mortality in patients who present with specific symptoms or microorganisms; nevertheless even then it often remains unclear when surgery should be performed. In this review we i) systematically reviewed the current literature comparing medical to surgical therapy to evaluate if surgery is the preferred option, ii) performed a meta-analysis of studies reporting propensity matched analyses, and iii), briefly summarized the current indications for surgery.
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Affiliation(s)
- Stuart J Head
- Department of Cardio-Thoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
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Delahaye F. Is early surgery beneficial in infective endocarditis? A systematic review. Arch Cardiovasc Dis 2011; 104:35-44. [DOI: 10.1016/j.acvd.2010.11.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2010] [Revised: 11/07/2010] [Accepted: 11/08/2010] [Indexed: 11/30/2022]
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Abstract
Cardiac complications caused by infective endocarditis (IE) are varied and frequently life-threatening. This article focuses on new data related to several complications, and summarizes the indications, timing, and type of valve surgery recommended in the management of IE. Several recent studies using propensity score techniques have resulted in disparate conclusions and underscore the need for randomized prospective studies to better address whether and when surgery should be performed in patients with IE. Mitral valve repair is an exciting new development in surgical methodology and probably will have increased application over the next two decades. Excellent reviews related to periannular abscesses, fistulae, acute coronary syndrome, and pericarditis have been published recently and are also summarized.
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Abstract
INTRODUCTION AND OBJECTIVES Prosthetic valve endocarditis is associated with high morbidity and mortality, particularly when urgent surgery is needed. The identification of factors that predict a poor prognosis is the first step in improving outcomes. The study objectives were to characterize patients with prosthetic valve endocarditis who need urgent surgery and to identify factors that predict in-hospital mortality in this high-risk group. METHODS From a database of 648 consecutive patients with infective endocarditis diagnosed between 1996 and 2006 at four tertiary-care centers with cardiac surgery facilities, 46 patients with left-sided prosthetic valve endocarditis who needed urgent surgery were identified. A retrospective study was carried out to determine these patients' main characteristics and to identify predictors of in-hospital mortality. RESULTS The main indications for urgent surgery were heart failure (57%) and persistent infection (33%). In-hospital mortality was 41%. Factors significantly associated with a poor prognosis were fever at admission, persistent infection, positive blood cultures, persistently positive cultures, and echocardiographic evidence of vegetations (P< .05). No specific microorganism was associated with a poor prognosis. CONCLUSIONS Prosthetic valve endocarditis was associated with high mortality when urgent surgery was needed. Although heart failure was the principle reason for urgent surgery, it did not lead to a worse in-hospital prognosis. The presence of vegetations and uncontrolled infection were the main factors associated with higher in-hospital mortality in patients with left-sided infective endocarditis who needed urgent surgery.
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Rasmussen RV, Bruun LE, Lund J, Larsen CT, Hassager C, Bruun NE. The impact of cardiac surgery in native valve infective endocarditis: can euroSCORE guide patient selection? Int J Cardiol 2010; 149:304-9. [PMID: 20178888 DOI: 10.1016/j.ijcard.2010.02.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Accepted: 02/04/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Decision making regarding surgical intervention in native valve endocarditis (NVE) is often complex and surgery is withheld in a number of patients either because medical treatment is considered the best treatment or because the risk of operation is considered too high. The objective of this study was to investigate the outcome of surgical treatment and to validate the ability of euroSCORE to predict operative mortality in NVE patients. METHODS Prospective cohort study including 323 consecutive NVE patients. Patients were divided into 3 groups based on treatment strategy and indication/contraindication for surgery. The additive and logistic euroSCORE was calculated and the observed and predicted mortality was compared. RESULTS Cardiac surgery was associated with a good prognosis, in-hospital and after 12months, compared to conservative treatment. After adjustment for confounders surgery was associated with a survival benefit (hazard ratio (HR) 0.45, 95% CI: 0.27-0.76%; p=0.003). When propensity score was used in regression adjustment, cardiac surgery was still associated with a better outcome after 12months (HR 0.41, 95% CI: 0.25-0.68; p<0.001). Observed mortality for patients receiving surgical treatment was 11% compared to a mean logistic euroSCORE mortality of 16% (NS). The discriminating ability of euroSCORE was good, area under the ROC curve 0.74 (95% CI: 0.64-0.84; p<0.001) logistic model and 0.75 (95% CI: 0.65-0.86; p<0.001) additive model. CONCLUSIONS Cardiac surgery was associated with a good prognosis when indicated regardless of euroSCORE, and surgery should only be withheld after thorough consideration. EuroSCORE remains a valuable tool to identify high-risk IE patients when surgery is considered.
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Affiliation(s)
- Rasmus V Rasmussen
- Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark.
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Lalani T, Cabell CH, Benjamin DK, Lasca O, Naber C, Fowler VG, Corey GR, Chu VH, Fenely M, Pachirat O, Tan RS, Watkin R, Ionac A, Moreno A, Mestres CA, Casabé J, Chipigina N, Eisen DP, Spelman D, Delahaye F, Peterson G, Olaison L, Wang A. Analysis of the impact of early surgery on in-hospital mortality of native valve endocarditis: use of propensity score and instrumental variable methods to adjust for treatment-selection bias. Circulation 2010; 121:1005-13. [PMID: 20159831 DOI: 10.1161/circulationaha.109.864488] [Citation(s) in RCA: 220] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The impact of early surgery on mortality in patients with native valve endocarditis (NVE) is unresolved. This study sought to evaluate valve surgery compared with medical therapy for NVE and to identify characteristics of patients who are most likely to benefit from early surgery. METHODS AND RESULTS Using a prospective, multinational cohort of patients with definite NVE, the effect of early surgery on in-hospital mortality was assessed by propensity-based matching adjustment for survivor bias and by instrumental variable analysis. Patients were stratified by propensity quintile, paravalvular complications, valve perforation, systemic embolization, stroke, Staphylococcus aureus infection, and congestive heart failure. Of the 1552 patients with NVE, 720 (46%) underwent early surgery and 832 (54%) were treated with medical therapy. Compared with medical therapy, early surgery was associated with a significant reduction in mortality in the overall cohort (12.1% [87/720] versus 20.7% [172/832]) and after propensity-based matching and adjustment for survivor bias (absolute risk reduction [ARR] -5.9%, P<0.001). With a combined instrument, the instrumental-variable-adjusted ARR in mortality associated with early surgery was -11.2% (P<0.001). In subgroup analysis, surgery was found to confer a survival benefit compared with medical therapy among patients with a higher propensity for surgery (ARR -10.9% for quintiles 4 and 5, P=0.002) and those with paravalvular complications (ARR -17.3%, P<0.001), systemic embolization (ARR -12.9%, P=0.002), S aureus NVE (ARR -20.1%, P<0.001), and stroke (ARR -13%, P=0.02) but not those with valve perforation or congestive heart failure. CONCLUSIONS Early surgery for NVE is associated with an in-hospital mortality benefit compared with medical therapy alone.
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Affiliation(s)
- Tahaniyat Lalani
- Naval Medical Center Portsmouth, Bldg 3, 1st Floor, 620 John Paul Jones Cir, Portsmouth, VA 23708, USA.
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Sy RW, Bannon PG, Bayfield MS, Brown C, Kritharides L. Survivor Treatment Selection Bias and Outcomes Research. Circ Cardiovasc Qual Outcomes 2009; 2:469-74. [DOI: 10.1161/circoutcomes.109.857938] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Raymond W. Sy
- From the Department of Cardiology, Concord Repatriation General Hospital (R.W.S., L.K.), and the Departments of Cardiology and Cardiothoracic Surgery, Royal Prince Alfred Hospital (R.W.S., P.G.B., M.S.B.), Sydney South Western Area Health Service, University of Sydney, Sydney, Australia; The Baird Surgical Research Institute (P.G.B., M.S.B.), Newton, Australia; and the National Health and Medical Research Council Clinical Trials Centre (C.B.), University of Sydney, Sydney, Australia
| | - Paul G. Bannon
- From the Department of Cardiology, Concord Repatriation General Hospital (R.W.S., L.K.), and the Departments of Cardiology and Cardiothoracic Surgery, Royal Prince Alfred Hospital (R.W.S., P.G.B., M.S.B.), Sydney South Western Area Health Service, University of Sydney, Sydney, Australia; The Baird Surgical Research Institute (P.G.B., M.S.B.), Newton, Australia; and the National Health and Medical Research Council Clinical Trials Centre (C.B.), University of Sydney, Sydney, Australia
| | - Matthew S. Bayfield
- From the Department of Cardiology, Concord Repatriation General Hospital (R.W.S., L.K.), and the Departments of Cardiology and Cardiothoracic Surgery, Royal Prince Alfred Hospital (R.W.S., P.G.B., M.S.B.), Sydney South Western Area Health Service, University of Sydney, Sydney, Australia; The Baird Surgical Research Institute (P.G.B., M.S.B.), Newton, Australia; and the National Health and Medical Research Council Clinical Trials Centre (C.B.), University of Sydney, Sydney, Australia
| | - Chris Brown
- From the Department of Cardiology, Concord Repatriation General Hospital (R.W.S., L.K.), and the Departments of Cardiology and Cardiothoracic Surgery, Royal Prince Alfred Hospital (R.W.S., P.G.B., M.S.B.), Sydney South Western Area Health Service, University of Sydney, Sydney, Australia; The Baird Surgical Research Institute (P.G.B., M.S.B.), Newton, Australia; and the National Health and Medical Research Council Clinical Trials Centre (C.B.), University of Sydney, Sydney, Australia
| | - Leonard Kritharides
- From the Department of Cardiology, Concord Repatriation General Hospital (R.W.S., L.K.), and the Departments of Cardiology and Cardiothoracic Surgery, Royal Prince Alfred Hospital (R.W.S., P.G.B., M.S.B.), Sydney South Western Area Health Service, University of Sydney, Sydney, Australia; The Baird Surgical Research Institute (P.G.B., M.S.B.), Newton, Australia; and the National Health and Medical Research Council Clinical Trials Centre (C.B.), University of Sydney, Sydney, Australia
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Chen MY, Zhong DD, Ying ZQ. Aorta-to-right atrium fistula, an unusual complication of endocarditis. J Zhejiang Univ Sci B 2009; 10:230-2. [PMID: 19283878 DOI: 10.1631/jzus.b0820229] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Infective endocarditis (IE) remains a serious disease. Aorta-to-right atrium fistula is a rare but very serious complication of IE and predicts a higher mortality. This report describes a 50-year-old man with endocarditis, vegetation, perforation of noncoronary sinus, and formation of two aorta-to-right atrium fistulas with native valves detected by transthoracic echocardiography. This disease is lethal despite developments in cardiac imaging and antibacterial therapy. Early diagnosis, aggressive antibacterial therapy, and surgical treatment may improve the prognosis.
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Affiliation(s)
- Miao-yan Chen
- Department of Internal Medicine, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China
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Delahaye F, de Gevigney G. Is surgery useful in infective endocarditis? Arch Cardiovasc Dis 2008; 101:685-6. [PMID: 19059562 DOI: 10.1016/j.acvd.2008.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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