Key result
Early surgery for mitral endocarditis was associated with lower 5-year freedom from the composite of >2+ regurgitation or reoperation compared to delayed surgery (72.7% vs 98.2%; P=0.004).
Why the study?
The optimal timing of surgery for infective endocarditis remains controversial.
Does early surgery compared to delayed surgery improve outcomes in patients with infective mitral endocarditis?
Cohort (n=91)
No
Does early surgery compared to delayed surgery improve outcomes in patients with infective mitral endocarditis?
Absolute Event Rate: 72.7% vs 98.2%
p-value: p=0.004
In patients with infective mitral endocarditis, early surgery (within 7 days of antibiotics) was associated with a higher rate of reoperations and recurrent mitral regurgitation compared to delayed surgery.
Optimal timing for mitral endocarditis surgery remains uncertain; retrospective analysis leaves open whether early intervention improves outcomes.
BACKGROUND AND AIM OF THE STUDY: Timing of surgery for infective endocarditis is controversial. The objective of this study was to report the outcomes of early vs delayed surgery (DS) of mitral endocarditis. METHODS: We retrospectively reviewed all patients treated surgically for mitral endocarditis between 2005 and 2016 in a single center. We analyzed midterm outcomes of early surgery (ES; surgery within 7 days or less of prior directed antibiotic treatment) in comparison to DS (surgery after more than 7 days of prior directed antibiotic treatment). RESULTS: Survival of all patients was 87% at one and 72% at 5 years. Mean follow-up time was 4.0 ± 3.1 years. Thirty-three (36.3%) patients were in the ES and 58 (63.7%) were in the DS group. Patients with ES were younger (47.4 vs 55.3 years), were in New York Heart Association class III or IV more frequently (97.0 vs 65.5%), and had higher EuroScore2 (15.6 vs 8.6%). The ES group had lower freedom from valve reoperation (98.2 vs 87.2%; P = .035) and the composite endpoint of >2 + regurgitation or reoperation at 5 years (98.2 vs 72.7%; P = .004). CONCLUSIONS: ES was associated with a higher rate of reoperations and the composite endpoint of recurrent MR or reoperation.
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Huuskonen et al. (2019) conducted a cohort in Infective mitral endocarditis (n=91). Early surgery (≤7 days of prior directed antibiotic treatment) vs. Delayed surgery (>7 days of prior directed antibiotic treatment) was evaluated on Freedom from the composite of >2+ regurgitation or reoperation at 5 years (p=0.004). Early surgery for mitral endocarditis was associated with lower 5-year freedom from the composite of >2+ regurgitation or reoperation compared to delayed surgery (72.7% vs 98.2%; P=0.004).
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