Long-term outcome of infective endocarditis: the impact of early surgical intervention.
To determine the impact of early surgical intervention on long-term survival in patients with infective endocarditis (IE), charts of all patients who had IE from January 1987 through December 1996 were reviewed. A total of 252 patients with definite or possible IE were included. Forty-four patients (17.5%) had early surgery on median hospital day 2 (range, 0-30 days), and 208 patients (82.5%) received medical treatment alone. On multivariate analysis, several variables, including early surgical intervention, improved long-term survival rates (hazard ratio, 1.5; P=.03), mainly in patients with Staphylococcus aureus etiology (P=.04). When patients with prosthetic devices were excluded, the median duration of survival for patients who had early surgery was >150 months, compared with 61.5 months for patients in the medical group (P=.1). Early surgical intervention compared with medical therapy alone is associated with increased short- and long-term survival rates in patients with IE, primarily when IE is caused by S. aureus.
Bishara
J
J
Department of Internal Medicine "C,", Rabin Medical Center, Beilinson Campus, Petach Tikvah, Israel.
Leibovici
L
L
Gartman-Israel
D
D
Sagie
A
A
Kazakov
A
A
Miroshnik
E
E
Ashkenazi
S
S
Pitlik
S
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001424:Bacterial Infections / Q000382:microbiology / Q000401:mortality* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D004697:Endocarditis, Bacterial / Q000382:microbiology / Q000401:mortality* / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome