Impact of early surgery in the active phase on long-term outcomes in left-sided native valve infective endocarditis

Objective: We sought to evaluate the impact of early surgery in the active phase on long-term outcomes in patients with left-sided native valve infective endocarditis. Methods: Clinical data were retrospectively reviewed in 212 consecutive patients with left-sided native valve infective endocarditis from 1990 to 2009. Early surgery in the active phase (within 2 weeks after the initial diagnosis) was performed in 73 patients, and the conventional treatment strategy was applied in 139 patients. In the conventional treatment group, 99 patients underwent late surgical intervention. To minimize selection bias, propensity score was used to match patients in the early operation and conventional treatment groups. Major adverse cardiac event was defined as a composite of infective endocarditis-related death, repeat surgery, and recurrence of infective endocarditis during follow-up. Results: The mean follow-up period was 5.5 years. In-hospital mortality was lower in the early operation group than in the conventional treatment group (5% vs 13%, P = .08). For 57 propensity score-matched pairs, the estimated actuarial 7-year survivals free from infective endocarditis-related death and major adverse cardiac events were significantly higher in the early operation group than in the conventional treatment group (infective endocarditis-related death: 94% +/- 5% vs 82% +/- 5%, P = .011, major adverse cardiac events: 88% +/- 5% vs 69% +/- 7%, P = .006, respectively). Conclusions: Compared with conventional treatment, early surgery in the active phase was associated with better long-term outcomes in patients with left-sided native valve infective endocarditis. Further prospective randomized studies with large study populations are necessary to evaluate more precisely the optimal timing of surgery in patients with native valve infective endocarditis. (J Thorac Cardiovasc Surg 2011; 142:836-42)