Operative management for IVDU-associated prosthetic valve endocarditis was associated with a borderline overall survival benefit compared to nonoperative management (HR 0.58; 95% CI 0.34-1.01; p=0.053).
Cohort (n=87)
No
Does operative management improve survival compared to nonoperative management in patients with intravenous drug use-associated prosthetic valve endocarditis?
Operative management for prosthetic valve endocarditis in patients with intravenous drug use may offer a survival benefit over medical therapy alone, despite these patients having higher baseline operative risk.
Hazard Ratio: 0.58 (95% CI 0.34–1.01)
Absolute Event Rate: 51% vs 31%
p-value: p=0.053
BACKGROUND Management of prosthetic valve endocarditis (PVE) in patients with intravenous drug use (IVDU) presents complex challenges, particularly in those with recidivism. We aim to evaluate decision-making and outcomes in operative versus nonoperative management for these patients. METHODS Patients at our institution with PVE and IVDU from 2011-2023 were identified. Data were collected from the Adult Cardiac Surgery Database and electronic medical record. Primary outcomes were surgical decision-making and mortality. RESULTS Among 87 patients with IVDU-associated PVE, 43 (49%) underwent reoperation. Median age was 37-years IQR 31-44. 67 (77%) patients had active drug use. The most frequent quoted factors in nonoperative decision-making included ongoing IVDU (50%), subjective operative risk (14%), and baseline comorbidities (11%). The most frequent reasons for operative management included offering a "last chance" (37%) and failure of antibiotic treatment (19%). Operative patients were more likely to have multi-valve involvement (30% vs 9%, p=0.01) and were at higher operative risk based on EuroSCORE (10% vs 6%, p<0.001). Nonoperative patients had higher 30-day mortality (27% vs 7%, p=0.01). Kaplan Meier estimates for 1- and 3-year survival were 46% vs 61% and 31% vs 51% for nonoperative and operative patients, respectively, with borderline operative survival benefit (HR 0.58, 95%CI 0.34–1.01, p=0.053). CONCLUSIONS This study provides insight into decision-making and outcomes for management of patients with PVE. Multidisciplinary engagement to comprehensively assess all options to treat patients with PVE is necessary to optimize outcomes for this population.
Miller et al. (Wed,) conducted a cohort in Prosthetic valve endocarditis with intravenous drug use (n=87). Operative management vs. Nonoperative management was evaluated on 3-year survival (HR 0.58, 95% CI 0.34-1.01, p=0.053). Operative management for IVDU-associated prosthetic valve endocarditis was associated with a borderline overall survival benefit compared to nonoperative management (HR 0.58; 95% CI 0.34-1.01; p=0.053).