Key result
Not performing cardiac surgery in patients with prosthetic valve endocarditis who had a surgical indication significantly increased in-hospital mortality compared to those who underwent surgery (51.3% vs 31.3%; OR 2.08).
Why the study?
Prosthetic valve endocarditis is a serious infection associated with high mortality that often requires surgical treatment.
Does cardiac surgery reduce in-hospital mortality in patients with prosthetic valve endocarditis who have a surgical indication?
Cohort (n=1,354)
Yes
Does cardiac surgery reduce in-hospital mortality in patients with prosthetic valve endocarditis who have a surgical indication?
Not performing indicated cardiac surgery in patients with prosthetic valve endocarditis is associated with significantly higher in-hospital mortality.
Answers are grounded in this paper and cite their sources.
Supports indicated surgery in prosthetic valve endocarditis; hypothesis-generating pending randomized confirmation.
BACKGROUND: Prosthetic valve endocarditis (PVE) is a serious infection associated with high mortality that often requires surgical treatment. METHODS: Study on clinical characteristics and prognosis of a large contemporary prospective cohort of prosthetic valve endocarditis (PVE) that included patients diagnosed between January 2008 and December 2020. Univariate and multivariate analysis of factors associated with in-hospital mortality was performed. RESULTS: The study included 1354 cases of PVE. The median age was 71 years with an interquartile range of 62-77 years and 66.9% of the cases were male. Patients diagnosed during the first year after valve implantation (early onset) were characterized by a higher proportion of cases due to coagulase-negative staphylococci and Candida and more perivalvular complications than patients detected after the first year (late onset). In-hospital mortality of PVE in this series was 32.6%; specifically, it was 35.4% in the period 2008-2013 and 29.9% in 2014-2020 (p = 0.031). Variables associated with in-hospital mortality were: Age-adjusted Charlson comorbidity index (OR: 1.15, 95% CI: 1.08-1.23), intracardiac abscess (OR:1.78, 95% CI:1.30-2.44), acute heart failure related to PVE (OR: 3. 11, 95% CI: 2.31-4.19), acute renal failure (OR: 3.11, 95% CI:1.14-2.09), septic shock (OR: 5.56, 95% CI:3.55-8.71), persistent bacteremia (OR: 1.85, 95% CI: 1.21-2.83) and surgery indicated but not performed (OR: 2.08, 95% CI: 1.49-2.89). In-hospital mortality in patients with surgical indication according to guidelines was 31.3% in operated patients and 51.3% in non-operated patients (p<0.001). In the latter group, there were more cases of advanced age, comorbidity, hospital acquired PVE, PVE due to Staphylococcus aureus, septic shock, and stroke. CONCLUSIONS: Not performing cardiac surgery in patients with PVE and surgical indication, according to guidelines, has a significant negative effect on in-hospital mortality. Strategies to better discriminate patients who can benefit most from surgery would be desirable.
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Ramos et al. (2023) conducted a cohort in Prosthetic valve endocarditis (n=1,354). Conservative management (surgery indicated but not performed) vs. Surgical treatment (surgery performed) was evaluated on In-hospital mortality (OR 2.08, 95% CI 1.49-2.89, p=<0.001). Not performing cardiac surgery in patients with prosthetic valve endocarditis who had a surgical indication significantly increased in-hospital mortality compared to those who underwent surgery (51.3% vs 31.3%; OR 2.08).
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