RT Journal Article
SR Electronic
T1 Prognostic impact of cardiac surgery in left-sided infective endocarditis according to risk profile
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 1987
OP 1994
DO 10.1136/heartjnl-2021-319661
VO 107
IS 24
A1 Garcia Granja, Pablo Elpidio
A1 Lopez, Javier
A1 Vilacosta, Isidre
A1 Saéz, Carmen
A1 Cabezón, Gonzalo
A1 Olmos, Carmen
A1 Jerónimo, Adrián
A1 Pérez, Javier B
A1 De Stefano, Salvatore
A1 Maroto, Luis
A1 Carnero, Manuel
A1 Monguio, Emilio
A1 Pulido, Paloma
A1 de Miguel, María
A1 Gomez Salvador, Itziar
A1 Carrasco-Moraleja, Manuel
A1 San Román, J Alberto
YR 2021
UL http://heart.bmj.com/content/107/24/1987.abstract
AB 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.All data relevant to the study are included in the article or uploaded as supplemental information. Not applicable.