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Association between surgical indications, operative risk, and clinical outcome in infective endocarditis: a prospective study from the International Collaboration on Endocarditis.

Publication ,  Journal Article
Chu, VH; Park, LP; Athan, E; Delahaye, F; Freiberger, T; Lamas, C; Miro, JM; Mudrick, DW; Strahilevitz, J; Tribouilloy, C; Durante-Mangoni, E ...
Published in: Circulation
January 13, 2015

BACKGROUND: Use of surgery for the treatment of infective endocarditis (IE) as related to surgical indications and operative risk for mortality has not been well defined. METHODS AND RESULTS: The International Collaboration on Endocarditis-PLUS (ICE-PLUS) is a prospective cohort of consecutively enrolled patients with definite IE from 29 centers in 16 countries. We included patients from ICE-PLUS with definite left-sided, non-cardiac device-related IE who were enrolled between September 1, 2008, and December 31, 2012. A total of 1296 patients with left-sided IE were included. Surgical treatment was performed in 57% of the overall cohort and in 76% of patients with a surgical indication. Reasons for nonsurgical treatment included poor prognosis (33.7%), hemodynamic instability (19.8%), death before surgery (23.3%), stroke (22.7%), and sepsis (21%). Among patients with a surgical indication, surgical treatment was independently associated with the presence of severe aortic regurgitation, abscess, embolization before surgical treatment, and transfer from an outside hospital. Variables associated with nonsurgical treatment were a history of moderate/severe liver disease, stroke before surgical decision, and Staphyloccus aureus etiology. The integration of surgical indication, Society of Thoracic Surgeons IE score, and use of surgery was associated with 6-month survival in IE. CONCLUSIONS: Surgical decision making in IE is largely consistent with established guidelines, although nearly one quarter of patients with surgical indications do not undergo surgery. Operative risk assessment by Society of Thoracic Surgeons IE score provides prognostic information for survival beyond the operative period. S aureus IE was significantly associated with nonsurgical management.

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Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

January 13, 2015

Volume

131

Issue

2

Start / End Page

131 / 140

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Staphylococcal Infections
  • Severity of Illness Index
  • Risk Assessment
  • Prospective Studies
  • Prognosis
  • Postoperative Complications
  • Patient Selection
  • Models, Theoretical
  • Middle Aged
 

Citation

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Chu, V. H., Park, L. P., Athan, E., Delahaye, F., Freiberger, T., Lamas, C., … International Collaboration on Endocarditis (ICE) Investigators*, . (2015). Association between surgical indications, operative risk, and clinical outcome in infective endocarditis: a prospective study from the International Collaboration on Endocarditis. Circulation, 131(2), 131–140. https://doi.org/10.1161/CIRCULATIONAHA.114.012461
Chu, Vivian H., Lawrence P. Park, Eugene Athan, Francois Delahaye, Tomas Freiberger, Cristiane Lamas, Jose M. Miro, et al. “Association between surgical indications, operative risk, and clinical outcome in infective endocarditis: a prospective study from the International Collaboration on Endocarditis.Circulation 131, no. 2 (January 13, 2015): 131–40. https://doi.org/10.1161/CIRCULATIONAHA.114.012461.
Chu, Vivian H., et al. “Association between surgical indications, operative risk, and clinical outcome in infective endocarditis: a prospective study from the International Collaboration on Endocarditis.Circulation, vol. 131, no. 2, Jan. 2015, pp. 131–40. Pubmed, doi:10.1161/CIRCULATIONAHA.114.012461.
Chu VH, Park LP, Athan E, Delahaye F, Freiberger T, Lamas C, Miro JM, Mudrick DW, Strahilevitz J, Tribouilloy C, Durante-Mangoni E, Pericas JM, Fernández-Hidalgo N, Nacinovich F, Rizk H, Krajinovic V, Giannitsioti E, Hurley JP, Hannan MM, Wang A, International Collaboration on Endocarditis (ICE) Investigators*. Association between surgical indications, operative risk, and clinical outcome in infective endocarditis: a prospective study from the International Collaboration on Endocarditis. Circulation. 2015 Jan 13;131(2):131–140.

Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

January 13, 2015

Volume

131

Issue

2

Start / End Page

131 / 140

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Staphylococcal Infections
  • Severity of Illness Index
  • Risk Assessment
  • Prospective Studies
  • Prognosis
  • Postoperative Complications
  • Patient Selection
  • Models, Theoretical
  • Middle Aged