Cardiac surgery timing on the prognosis of patients with infective endocarditis

BACKGROUND: Infective endocarditis (IE) is a disease caused by the involvement of pathogenic microorganisms in the endocardium, primarily characterized by the formation of growths and progressive valve damage. Despite advances in diagnostic and therapeutic methods, the mortality rate remains high. Conventional treatment typically favors surgery after 4-6 weeks of infection control. Although a series of articles on early surgical treatment have been published in recent years, outcomes for early surgical treatment continue to vary. METHODS: By collecting the clinical data of 166 patients who underwent cardiac surgery for IE between February 1, 2017, and January 31, 2023, we classified the patients into three groups: Group A (radical surgery within 1-7 days after admission), Group B (surgical treatment 8-13 days after admission), and Group C (surgical treatment 14-28 days after admission) according to different treatment strategies. To compare the effects of different times of surgical intervention on the early prognosis of patients, logistic multivariate regression analysis was used to determine the risk factors associated with surgical mortality, and the survival of different groups of patients was compared using Kaplan-Meier survival analysis. RESULTS: The results showed no significant differences in perioperative reinfarction, endocarditis recurrence, heart failure, or in-hospital mortality among the three treatment groups. However, ICU length of stay (P=0.015, 1.30 [1.05-1.61]), cardiac malfunction (P=0.015, 22.28 [1.82-273.04]), and other organ malfunctions (P=0.007, 29.21 [2.46-346.49]) were identified as risk factors affecting patient mortality. CONCLUSIONS: Early surgical intervention did not increase the risk of death in patients with IE, nor did it increase the risk of recurrence and reoperation within one year. Therefore, we recommend early surgical intervention before completing a cycle of antibiotics in patients with a clear diagnosis, unstable cardiac function, or risk of recurrent embolism.