Key result
Surgery for active infective endocarditis was associated with 27.27% in-hospital mortality, with severe congestive heart failure strongly predicting death (HR 13.82; 95% CI 3.38-38.15; P<0.001).
Cohort (n=88)
No
Surgery for active infective endocarditis carries a high early mortality rate (27.27%), strongly predicted by severe heart failure and large vegetations, though long-term outcomes for survivors remain satisfactory.
High mortality after surgery for active infective endocarditis with severe heart failure cautions operative decisions; leaves open optimal timing via randomized trials.
From January 1997 to December 2006, all patients with a Duke criteria-based definite diagnosis of infective endocarditis (IE) operated on during the active phase in a Tunisian high volume tertiary-care centre were included. Among the 186 patients with IE identified during the study period, 88 (48.35%) required surgery in the active phase. Mean age was 34.9 years, 54 (61.4%) were men. The infected valve was native in 70 cases (79.5%) and prosthetic in 18 (20.5%). Streptococcus sp. were the most common causative microorganisms. The most frequent indication for operation was congestive heart failure. There were 24 in-hospital deaths (27.27% early mortality). By multivariate analysis, severe congestive heart failure (HR=13.82, 95% CI [3.38-38.15], P<0.001) and large >15 mm vegetations (HR=6.02, 95% CI [1.48-18.52], P=0.03) were predictive of in-hospital mortality. Survivors were followed-up from 3 to 120 months, mean of 28.6. Actuarial 5- and 10-year survivals free from the combined endpoint of recurrent IE, cardiovascular death and late surgery in survivors were 69+/-5% and 63+/-7%, respectively. In conclusion, despite medical progress, surgery for endocarditis in Tunisia remains challenging and yields high mortality rates. Severe heart failure is the most powerful predictor of mortality. Long-term outcome is, however, satisfactory.
No takes yet. Share an insight, caveat, or question.
Rekik et al. (2009) conducted a cohort in Active infective endocarditis (n=88). Surgery for active infective endocarditis was evaluated on In-hospital mortality. Surgery for active infective endocarditis was associated with 27.27% in-hospital mortality, with severe congestive heart failure strongly predicting death (HR 13.82; 95% CI 3.38-38.15; P<0.001).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: