Please use this identifier to cite or link to this item: https://www.arca.fiocruz.br/handle/icict/33364
Title: Association between the timing of surgery for complicated, left-sided infective endocarditis and survival
Authors: Wang, Andrew
Chu, Vivian H.
Athan, Eugene
Delahaye, Francois
Freiberger, Tomas
Lamas, Cristiane
Miro, Jose M.
Strahilevitz, Jacob
Tribouilloy, Christophe
Durante-Mangoni, Emanuele
Pericas, Juan M.
Fernández-Hidalgo, Nuria
Nacinovich, Francisco
Barsic, Bruno
Giannitsioti, Efthymia
Hurley, John P.
Hannan, Margaret M.
Park, Lawrence P.
Affilliation: Duke University Medical Center. Durham, NC, USA.
Duke University Medical Center. Durham, NC, USA.
Barwon Health and Deakin University. Geelong, Australia.
Hospital Louis Pradel. Lyon. France.
Centre for Cardiovascular Surgery and Transplantation. Brno, Czech Republic / Masaryk University. Central European Institute of Technology. Brno, Czech Republic.
Instituto Nacional de Cardiologia. Rio de Janeiro, RJ, Brasil / Universidade do Grande Rio. Rio de Janeiro, RJ, Brasil.
University of Barcelona. Hospital Clinic–IDIBAPS. Infectious Diseases Service. Barcelona, Spain.
Hadassah-Hebrew University Medical Center. Jerusalem, Israel.
University Hospital. Amiens, France / University of Picardie. INSERM U-1088. Amiens, France.
University of Campania. Monaldi Hospital. Internal Medicine. Naples, Italy.
University of Barcelona. Hospital Clinic–IDIBAPS. Infectious Diseases Service. Barcelona, Spain.
Universitat Autònoma de Barcelona. Hospital Universitari Vall d'Hebron. Servei de Malalties Infeccioses. Barcelona, Spain.
Instituto Cardiovascular de Buenos Aires. Buenos Aires, Argentina.
University of Zagreb. School of Medicine , Hospital for Infectious Diseases. Zagreb, Croatia.
Attikon University General Hospital. Athens, Greece.
Mater Misericordiae University Hospital. Dublin, Ireland.
Mater Misericordiae University Hospital. Dublin, Ireland.
Duke University Medical Center, Durham, NC, USA.
Abstract: Background: In patients with active infective endocarditis (IE), the relationship between timing of surgery and survival is uncertain. The objective was to evaluate clinical characteristics associated with timing of surgery and the association between surgical timing and 6-month survival in complicated, left-sided IE. Methods: In a prospective, multicenter, observational registry (The International Collaboration on Endocarditis-PLUS, registry from 2008 to 2012), clinical factors associated with timing of surgery during the index hospitalization were determined among 485 adult patients with definite, complicated, left-sided IE who underwent cardiac surgery during their index hospitalization. The relationship between early surgical intervention (b7 days from admission to surgery center) and outcome after surgery was analyzed. The primary end point of the study was 6-month survival. Results: The median time to surgery from admission to surgical center was 7 (interquartile range 2-15) days. Patients who underwent earlier surgery were more likely transferred to the surgical center (74.2% vs 46.4%, P b .001) and had a lower percentage of preexisting heart failure (before IE diagnosis) (6.0% vs 17.3%, P b .001) but higher rate of acute heart failure (53.2% vs 38.4%, P = .001). Variables independently associated with surgery b7 days from admission were patient transfer, acute heart failure, and nonelective surgical status (C-index = 0.84), but predicted operative risk was not. Cox proportional hazards modeling with inverse probability of treatment weighting found that earlier surgery was associated with a trend toward higher 6-month mortality compared with later surgery (hazard ratio = 1.68, 95% CI 0.97-2.96; P = .065), particularly surgery within 2 days of admission or transfer. Mortality was significantly associated with operative risk and complicated IE, including Staphylococcus aureusinfection and presence of abscess. Conclusions: Earlier surgery in IE is strongly associated with acute heart failure and surgical urgency. After adjustment for operative risk and IE complications, earlier surgery b7 days from admission was associated with a trend toward higher 6-month overall mortality compared with surgery later in the index hospitalization. (Am Heart J 2019;210:108-116.)
Keywords: Infective endocarditis
Surgery
Issue Date: 2019
Publisher: Elsevier
Citation: WANG, Andrew et al. Association between the timing of surgery for complicated, left-sided infective endocarditis and survival. American Heart Journal, v. 210, p. 108-116, Apr. 2019.
Description: Cristiane Lamas. Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Documento produzido em parceria ou por autor vinculado à Fiocruz, mas não consta a informação no documento.
DOI: 10.1016/j.ahj.2019.01.004
ISSN: 0002-8703
Copyright: restricted access
Appears in Collections:INI - Artigos de Periódicos

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