The use and effect of surgical therapy for prosthetic valve infective endocarditis: A propensity analysis of a multicenter, international cohort - 21/08/11
International Collaboration on Endocarditis Investigatorsg
No authors have any conflict of interest to disclose regarding the work presented in this manuscript.
Résumé |
Background |
Although surgical intervention is often used in the treatment of prosthetic valve infective endocarditis (PVIE), an understanding of its effect on survival has been limited by the biases of observational studies and lack of controlled trials.
Methods |
The International Collaboration on Endocarditis Merged Database is a large, multicenter, international registry of patients with definite endocarditis by Duke criteria, including 367 patients with PVIE. Clinical, microbiologic, and echocardiographic variables were analyzed to determine those factors associated with the use of surgery for PVIE. Logistic regression analysis was performed to create a propensity model of predictors of surgery use. Patients who underwent surgery during initial hospitalization were matched by propensity score with patients treated with medical therapy alone. Logistic regression analysis was performed to determine variables independently associated with inhospital mortality in this matched subset.
Results |
Surgical therapy for PVIE was performed in 148 (42%) of 367 patients. Inhospital mortality was similar for patients treated with surgery compared with those treated with medical therapy alone (25.0% vs 23.4%, P = .729). Surgical therapy was independently associated with patient age, microorganism, intracardiac abscess, and congestive heart failure. After adjustment for these determinants, inhospital mortality was predicted by brain embolization (OR 11.12, 95% CI 4.16-29.73) and Staphylococcus aureus infection (OR 3.67, 95% CI 1.29-9.74), with a trend toward benefit for surgery (OR 0.56, 95% CI 0.23-1.36).
Conclusions |
Despite the frequent use of surgery for the treatment of PVIE, this condition continues to be associated with a high inhospital mortality rate in the contemporary era. After adjustment for factors related to surgical intervention, brain embolism and S aureus infection were independently associated with inhospital mortality and a trend toward a survival benefit of surgery was evident.
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Guest editor of this manuscript is Lawrence H. Cohn, MD. |
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This study was supported in part by the following: American Heart Association GIA 0455802U (AW) and BGIA 0265405U (CHC); National Institutes of Health K23 AI-01647 (VGF) and K23 HL70861-01 (CHC); Tenet Healthcare Foundation (Santa Barbara, Calif) (EA); Red Española de Investigación en Patología Infecciosa (V-2003-REDC14A-O) (JMM); Fundación Privada Máximo Soriano Jiménez (Barcelona, Spain) (JMM); and Institut d'Investigacions Biomèdiques August Pii Sunyer (Barcelona, Spain) (JMM). |
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Guest editor of this manuscript is Lawrence H. Con, MD. This study was supported in part of the following: American Heart Association GIA 0455802U (AW) and BGIA 0265405U (CHC), National Institutes of Health K23 AI-01647 (VGF) and K23 HL70861-01 (CHC), Tenet Healthcare Foundation (Santa Barbara, CA) (EA), Red Española de Investigación en Patología Infecciosa (V-2003-REDC14A-O) (JMM), Fundación Privada Máximo Soriano Jiménez (Barcelona, Spain) (JMM), and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS, Barcelona Spain) (JMM). |
Vol 150 - N° 5
P. 1086-1091 - novembre 2005 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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