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

被引:225
作者
Chu, Vivian H. [1 ]
Park, Lawrence P. [1 ]
Athan, Eugene [2 ,3 ]
Delahaye, Francois [4 ]
Freiberger, Tomas [5 ,6 ]
Lamas, Cristiane [7 ,8 ]
Miro, Jose M. [9 ]
Mudrick, Daniel W. [10 ]
Strahilevitz, Jacob [11 ]
Tribouilloy, Christophe [12 ,13 ]
Durante-Mangoni, Emanuele [14 ]
Pericas, Juan M. [9 ]
Fernandez-Hidalgo, Nuria [15 ]
Nacinovich, Francisco [16 ]
Rizk, Hussien [17 ]
Krajinovic, Vladimir [18 ]
Giannitsioti, Efthymia [19 ]
Hurley, John P. [20 ]
Hannan, Margaret M. [20 ]
Wang, Andrew [1 ]
机构
[1] Duke Univ, Med Ctr, Durham, NC 27710 USA
[2] Barwon Hlth, Geelong, Vic, Australia
[3] Deakin Univ, Geelong, Vic 3217, Australia
[4] Hosp Louis Pradel, Lyon, France
[5] Ctr Cardiovasc Surg & Transplantat, Brno, Czech Republic
[6] Masaryk Univ, Cent European Inst Technol, Brno, Czech Republic
[7] Inst Nacl Cardiol, Rio De Janeiro, Brazil
[8] Unigranrio, Rio De Janeiro, Brazil
[9] Univ Barcelona, Infect Dis Serv, Hosp Clin, August Pi & Sunyer Biomed Res Inst, Barcelona, Spain
[10] OhioHlth Heart & Vasc Phys, Columbus, OH USA
[11] Hadassah Hebrew Univ, Med Ctr, Jerusalem, Israel
[12] Univ Hosp, Amiens, France
[13] Univ Picardie, INSERM U1088, Amiens, France
[14] Univ Naples SUN, Monaldi Hosp, Naples, Italy
[15] Univ Autonoma Barcelona, Hosp Univ Vall dHebron, E-08193 Barcelona, Spain
[16] Inst Cardiovasc Buenos Aires, Buenos Aires, DF, Argentina
[17] Cairo Univ Hosp, Cairo, Egypt
[18] Univ Hosp Infect Dis, Zagreb, Croatia
[19] Attikon Univ, Gen Hosp, Athens, Greece
[20] Mater Misericordiae Univ Hosp, Dublin, Ireland
关键词
endocarditis; infection; mortality; surgery; valve; NATIVE VALVE ENDOCARDITIS; STAPHYLOCOCCUS-AUREUS; ANTIMICROBIAL THERAPY; CARDIAC-SURGERY; MANAGEMENT; MULTICENTER; MORTALITY; DIAGNOSIS; IMPACT; COMPLICATIONS;
D O I
10.1161/CIRCULATIONAHA.114.012461
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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.
引用
收藏
页码:131 / U46
页数:13
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