HIGHLIGHTS
- •Staphylococcus Aureus infection is an independent predictor of systemic embolism.
- •Operated patients with complicated IE had a similar outcome as uncomplicated ones.
- •Survival rate was better for early compared to delayed surgery
ABSTRACT
Background
In patients with left-sided infective endocarditis (IE) and heart failure associated
with large vegetations, early surgery prevents embolic events. However, optimal timing
of surgery for other indications is still unresolved particularly when the presence
of large vegetations represents the sole indication.
Methods
We retrospectively analyzed 308 consecutive patients admitted to our department with
definite left-sided IE. Of these patients, 243 (79%) underwent cardiac surgery (complicated
IE), 34 patients with uncomplicated IE received medical treatment, 24 were not operated
due to prohibitive general conditions and 7 refused surgery. Long-term follow-up was
obtained by structured telephone interviews.
Results
During the 6-year follow-up (average 121.8 weeks ± 76), patients not operated because
of general conditions or refusal had the worst prognosis, while outcome in operated
patients for complicated IE was comparable to that of uncomplicated IE treated medically.
Early (<2 weeks from diagnosis) surgery was associated with better survival compared
to delayed surgery (HR 0.58, p = 0.23). Embolic events were detected at admission
in 38% of cases; Staphylococcus Aureus etiology and vegetation size were independently
associated with embolism (OR 2.4, p = 0.01; OR 1, p=0.008 respectively).
Conclusions
Compared to uncomplicated medically-treated patients, complicated IE showed comparable
survival when managed aggressively by surgical intervention, whereas a conservative
approach was associated with an adverse prognosis. Staphylococcus Aureus infection
and vegetation size were independent predictors of systemic embolism. Our data support
aggressive surgical management of complicated IE patients and highlight the importance
of etiological characterization in clinical decision-making.
Keywords
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Article info
Publication history
Published online: April 18, 2020
Accepted:
April 4,
2020
Received in revised form:
March 13,
2020
Received:
January 19,
2020
Identification
Copyright
© 2020 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
