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Prognostic impact of cardiac surgery in left-sided infective endocarditis according to risk profile
  1. Pablo Elpidio Garcia Granja1,2,
  2. Javier Lopez1,2,
  3. Isidre Vilacosta3,
  4. Carmen Saéz4,
  5. Gonzalo Cabezón1,
  6. Carmen Olmos3,
  7. Adrián Jerónimo3,
  8. Javier B Pérez4,
  9. Salvatore De Stefano5,
  10. Luis Maroto6,
  11. Manuel Carnero6,
  12. Emilio Monguio7,
  13. Paloma Pulido1,
  14. María de Miguel1,
  15. Itziar Gomez Salvador8,
  16. Manuel Carrasco-Moraleja8,
  17. J Alberto San Román1,2
  1. 1 Department of Cardiology, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario Valladolid, Valladolid, Spain
  2. 2 CIBER Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
  3. 3 Department of Cardiology. Instituto Cardiovascular. Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Hospital Clínico San Carlos, Madrid, Spain
  4. 4 Internal Medicine Department, Instituto de investigación Sanitaria del Hospital Universitario de la Princesa (IIS-IP), Madrid, Spain
  5. 5 Department of Cardiac Surgery. Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario Valladolid, Valladolid, Spain
  6. 6 Department of Cardiac Surgery, Instituto Cardiovascular, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Hospital Clínico San Carlos, Madrid, Spain
  7. 7 Department of Cardiac Surgery, Instituto de Investigación Sanitaria del Hospital Universitario de la Princesa (IIS-IP), Hospital Universitario La Princesa, Madrid, Spain
  8. 8 Biostatistics Department, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario Valladolid, Valladolid, Spain
  1. Correspondence to Dr Pablo Elpidio Garcia Granja, Department of Cardiology, Hospital Clínico Universitario Valladolid, Valladolid 47005, Spain; pabloelpidio88{at}gmail.com

Abstract

Objective To evaluate the prognostic impact of urgent cardiac surgery on the prognosis of left-sided infective endocarditis (LSIE) and its relationship to the basal risk of the patient and to the surgical indication.

Methods 605 patients with LSIE and formal surgical indication were consecutively recruited between 2000 and 2020 among three tertiary centres: 405 underwent surgery during the active phase of the disease and 200 did not despite having indication. The prognostic impact of urgent surgery was evaluated by multivariable analysis and propensity score analysis. We studied the benefit of surgery according to baseline mortality risk defined by the ENDOVAL score and according to surgical indication.

Results Surgery is an independent predictor of survival in LSIE with surgical indication both by multivariable analysis (OR 0.260, 95% CI 0.162 to 0.416) and propensity score (mortality 40% vs 66%, p<0.001). Its greatest prognostic benefit is seen in patients at highest risk (predicted mortality 80%–100%: OR 0.08, 95% CI 0.021 to 0.299). The benefit of surgery is especially remarkable for uncontrolled infection indication (OR 0.385, 95% CI 0.194 to 0.765), even in combination with heart failure (OR 0.220, 95% CI 0.077 to 0.632).

Conclusions Surgery during active LSIE seems to significantly reduce in-hospital mortality. The higher the risk, the higher the improvement in outcome.

  • infective endocarditis
  • cardiac surgery
  • mortality
  • risk score
  • ENDOVAL score

Data availability statement

All data relevant to the study are included in the article or uploaded as supplemental information. Not applicable.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplemental information. Not applicable.

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Footnotes

  • Twitter @manuel_carneri

  • Correction notice This article has been corrected since it was first published. Author 'Alberto San Román' has been updated to 'J Alberto San Román' and their affiliations have been amended.

  • Contributors PEGG, JL, IV, CS, CO, MC and ASR were involved in the conceptualisation of the study. PEGG, CS, GC, CO, AJ, JBP, SdS, LM, MC, EM, PP and MdM were involved in the acquisition of the data and conduct of the study. IG and MC performed the statistical analysis. PEGG, JL, IV, CS, CO, SdS, EM, MC and ASR were involved in the interpretation of the data. All authors contributed to drafting this manuscript, with PEGG taking a lead role; he is also the guarantor of the manuscript. All authors gave intellectual input to improve the manuscript, and have read and approved the final version.

  • Funding This work was supported by 'Gerencia Regional de Salud de la Junta de Castilla y León' (GRS 1523/A/17).

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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