Outcome after surgical treatment performed within the first week of antimicrobial therapy during infective endocarditis: a prospective study

Arch Cardiovasc Dis. Nov-Dec 2008;101(11-12):687-95. doi: 10.1016/j.acvd.2008.09.006. Epub 2008 Nov 18.

Abstract

Background: An increasing number of patients with infective endocarditis (IE) are operated on before the end of the first week of antimicrobial therapy. The mortality and morbidity of this specific group are unknown.

Aims: To evaluate the outcome of patients with IE requiring cardiac surgery performed within the first week of antimicrobial therapy.

Methods: All consecutive patients with a definite diagnosis of IE operated on within the first week of antimicrobial therapy were followed prospectively. Endpoints were in-hospital mortality and a combined endpoint of long-term cardiovascular death, recurrence and non-infective postoperative valvular dysfunction (PVD). The three main conditions requiring surgery, namely haemodynamic impairment, high embolic risk and periannular extension, were tested as potential predictors of outcome after adjustment for relevant variables.

Results: Among the 95 patients included, surgery was performed a median time of 3 days after starting antimicrobial therapy. In-hospital mortality was 15%. The 3-year cumulative rates of the combined endpoint and of cardiovascular death were 38+/-7% and 27+/-7%, respectively. Recurrence occurred in 12% and PVD in 7%. Periannular extension was the main predictor of in-hospital death and the combined endpoint.

Conclusion: Despite the short time between starting antimicrobial therapy and performing surgery, the risk of death, recurrence and PVD does not appear excessively high. In the presence of periannular extension, however, surgery is associated with a greater risk of postoperative events.

MeSH terms

  • Adult
  • Aged
  • Anti-Infective Agents / administration & dosage*
  • Cardiac Surgical Procedures* / adverse effects
  • Cardiac Surgical Procedures* / mortality
  • Combined Modality Therapy
  • Databases as Topic
  • Drug Administration Schedule
  • Endocarditis / drug therapy*
  • Endocarditis / mortality
  • Endocarditis / surgery*
  • Female
  • Heart Valve Prosthesis / adverse effects*
  • Hospital Mortality
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Proportional Hazards Models
  • Prospective Studies
  • Prosthesis-Related Infections / drug therapy*
  • Prosthesis-Related Infections / mortality
  • Prosthesis-Related Infections / surgery*
  • Recurrence
  • Risk Assessment
  • Time Factors
  • Treatment Outcome

Substances

  • Anti-Infective Agents