Valve surgery in active infective endocarditis: a simple score to predict in-hospital prognosis.


Journal Article

Surgery for infective endocarditis (IE) is associated with high mortality. Our objectives were to describe the experience with surgical treatment for IE in Spain, and to identify predictors of in-hospital mortality.Prospective cohort of 1000 consecutive patients with IE. Data were collected in 26 Spanish hospitals.Surgery was performed in 437 patients (43.7%). Patients treated with surgery were younger and predominantly male. They presented fewer comorbid conditions and more often had negative blood cultures and heart failure. In-hospital mortality after surgery was lower than in the medical therapy group (24.3 vs 30.7%, p=0.02). In patients treated with surgery, endocarditis involved a native valve in 267 patients (61.1%), a prosthetic valve in 122 (27.9%), and a pacemaker lead with no clear further valve involvement in 48 (11.0%). The most common aetiologies were Staphylococcus (186, 42.6%), Streptococcus (97, 22.2%), and Enterococcus (49, 11.2%). The main indications for surgery were heart failure and severe valve regurgitation. A risk score for in-hospital mortality was developed using 7 prognostic variables with a similar predictive value (OR between 1.7 and 2.3): PALSUSE: prosthetic valve, age ≥ 70, large intracardiac destruction, Staphylococcus spp, urgent surgery, sex [female], EuroSCORE ≥ 10. In-hospital mortality ranged from 0% in patients with a PALSUSE score of 0 to 45.4% in patients with PALSUSE score >3.The prognosis of IE surgery is highly variable. The PALSUSE score could help to identify patients with higher in-hospital mortality.

Full Text

Cited Authors

  • Martínez-Sellés, M; Muñoz, P; Arnáiz, A; Moreno, M; Gálvez, J; Rodríguez-Roda, J; de Alarcón, A; García Cabrera, E; Fariñas, MC; Miró, JM; Montejo, M; Moreno, A; Ruiz-Morales, J; Goenaga, MA; Bouza, E; Spanish Collaboration on Endocarditis — Grupo de Apoyo al Manejo de la Endocarditis infecciosa en ESpaña (GAMES),

Published Date

  • July 2014

Published In

Volume / Issue

  • 175 / 1

Start / End Page

  • 133 - 137

PubMed ID

  • 24852838

Pubmed Central ID

  • 24852838

Electronic International Standard Serial Number (EISSN)

  • 1874-1754

International Standard Serial Number (ISSN)

  • 0167-5273

Digital Object Identifier (DOI)

  • 10.1016/j.ijcard.2014.04.266


  • eng