Association between surgical indications, operative risk, and clinical outcome in infective endocarditis: a prospective study from the International Collaboration on Endocarditis

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. The International Collaboration on Endocarditis-PLUS (ICE-PLUS) is a prospective cohort of consecutively enrolled patients with definite IE f...

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Bibliographic Details
Published in:Circulation (New York, N.Y.) N.Y.), 2015-01, Vol.131 (2), p.131-140
Main Authors: Chu, Vivian H, Park, Lawrence P, Athan, Eugene, Delahaye, Francois, Freiberger, Tomas, Lamas, Cristiane, Miro, Jose M, Mudrick, Daniel W, Strahilevitz, Jacob, Tribouilloy, Christophe, Durante-Mangoni, Emanuele, Pericas, Juan M, Fernández-Hidalgo, Nuria, Nacinovich, Francisco, Rizk, Hussien, Krajinovic, Vladimir, Giannitsioti, Efthymia, Hurley, John P, Hannan, Margaret M, Wang, Andrew
Format: Article
Language:English
Subjects:
Abscess - epidemiology
Aged
Anti-Infective Agents - therapeutic use
Bacteremia - drug therapy
Bacteremia - epidemiology
Comorbidity
Cross Infection - drug therapy
Cross Infection - mortality
Cross Infection - surgery
Embolism - etiology
Endocarditis - drug therapy
Endocarditis - mortality
Endocarditis - surgery
Female
Follow-Up Studies
Heart Valve Prosthesis Implantation - statistics & numerical data
Heart Valves - microbiology
Heart Valves - surgery
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Models, Theoretical
Patient Selection
Postoperative Complications - epidemiology
Prognosis
Prospective Studies
Risk Assessment
Severity of Illness Index
Staphylococcal Infections - drug therapy
Staphylococcal Infections - mortality
Treatment Outcome
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Summary: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. 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. 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.
ISSN:0009-7322
1524-4539
DOI:10.1161/CIRCULATIONAHA.114.012461