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Association between the timing of surgery for complicated, left-sided infective endocarditis and survival.

Publication ,  Journal Article
Wang, A; Chu, VH; Athan, E; Delahaye, F; Freiberger, T; Lamas, C; Miro, JM; Strahilevitz, J; Tribouilloy, C; Durante-Mangoni, E; Pericas, JM ...
Published in: Am Heart J
April 2019

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 (<7 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 < .001) and had a lower percentage of preexisting heart failure (before IE diagnosis) (6.0% vs 17.3%, P < .001) but higher rate of acute heart failure (53.2% vs 38.4%, P = .001). Variables independently associated with surgery <7 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 aureus infection 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 <7 days from admission was associated with a trend toward higher 6-month overall mortality compared with surgery later in the index hospitalization.

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Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

April 2019

Volume

210

Start / End Page

108 / 116

Location

United States

Related Subject Headings

  • Time-to-Treatment
  • Surgical Procedures, Operative
  • Staphylococcus aureus
  • Staphylococcal Infections
  • Risk Factors
  • Prospective Studies
  • Proportional Hazards Models
  • Propensity Score
  • Patient Transfer
  • Middle Aged
 

Citation

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Wang, A., Chu, V. H., Athan, E., Delahaye, F., Freiberger, T., Lamas, C., … ICE-PLUS Investigators, . (2019). Association between the timing of surgery for complicated, left-sided infective endocarditis and survival. Am Heart J, 210, 108–116. https://doi.org/10.1016/j.ahj.2019.01.004
Wang, Andrew, Vivian H. Chu, Eugene Athan, Francois Delahaye, Tomas Freiberger, Cristiane Lamas, Jose M. Miro, et al. “Association between the timing of surgery for complicated, left-sided infective endocarditis and survival.Am Heart J 210 (April 2019): 108–16. https://doi.org/10.1016/j.ahj.2019.01.004.
Wang A, Chu VH, Athan E, Delahaye F, Freiberger T, Lamas C, et al. Association between the timing of surgery for complicated, left-sided infective endocarditis and survival. Am Heart J. 2019 Apr;210:108–16.
Wang, Andrew, et al. “Association between the timing of surgery for complicated, left-sided infective endocarditis and survival.Am Heart J, vol. 210, Apr. 2019, pp. 108–16. Pubmed, doi:10.1016/j.ahj.2019.01.004.
Wang A, Chu VH, Athan E, Delahaye F, Freiberger T, Lamas C, Miro JM, Strahilevitz J, Tribouilloy C, Durante-Mangoni E, Pericas JM, Fernández-Hidalgo N, Nacinovich F, Barsic B, Giannitsioti E, Hurley JP, Hannan MM, Park LP, ICE-PLUS Investigators. Association between the timing of surgery for complicated, left-sided infective endocarditis and survival. Am Heart J. 2019 Apr;210:108–116.
Journal cover image

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

April 2019

Volume

210

Start / End Page

108 / 116

Location

United States

Related Subject Headings

  • Time-to-Treatment
  • Surgical Procedures, Operative
  • Staphylococcus aureus
  • Staphylococcal Infections
  • Risk Factors
  • Prospective Studies
  • Proportional Hazards Models
  • Propensity Score
  • Patient Transfer
  • Middle Aged