title: Use of surgery in patients with native valve infective endocarditis: results from the International Collaboration on Endocarditis Merged Database.
abstract: BACKGROUND
  Early surgery has been shown to be beneficial for patients with infective endocarditis (IE), yet surgery is not used in most patients. Evidence of the uncertainty around the use of surgery can be found in the wide variations in the use of cardiac surgery in IE with few precise indications for cardiac surgery yet defined. The aim of the study was to characterize patients with native valve IE relative to surgery and to determine if patients who benefit from an early surgical intervention can be identified.
  
  
  METHODS
  The International Collaboration on Endocarditis Merged Database was used to quantify the differences between patients with IE receiving medical and surgical intervention in 1516 patients with definite native valve IE. Propensity models were built to identify a group of patients that benefit from early surgery.
  
  
  RESULTS
  Patients in the early surgical group were more likely to be male, younger, and with less comorbidities compared with the early medical group (P < .001 for all) and were less likely to have infection with Staphylococcus aureus or viridans group streptococci (P < .05 for all). Intracardiac abscess and heart failure were much more common in the surgical group (P < .001 for all). In an unadjusted comparison, there was no statistically significant survival advantage in the surgical group. However, in the propensity analysis, in the subgroup of patients with the most indications for surgery, there was a significant decrease in mortality associated with early surgery (11.2% vs 38.0%, P < .001).
  
  
  CONCLUSIONS
  The benefits of surgery are not seen uniformly in all patients with native valve IE, but are most realized in a targeted population. This observation requires confirmation in other populations of patients with definite IE.
authors.affiliation: Duke University Medical Center, Durham, NC, USA. chris.cabell@duke.edu
authors.forename: Christopher H
authors.initials: CH
authors.lastname: Cabell
authors.forename: Elias
authors.initials: E
authors.lastname: Abrutyn
authors.forename: Vance G
authors.initials: VG
authors.lastname: Fowler
authors.forename: Bruno
authors.initials: B
authors.lastname: Hoen
authors.forename: Jose M
authors.initials: JM
authors.lastname: Miro
authors.forename: G Ralph
authors.initials: GR
authors.lastname: Corey
authors.forename: Lars
authors.initials: L
authors.lastname: Olaison
authors.forename: Paul
authors.initials: P
authors.lastname: Pappas
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Anstrom
authors.forename: Judith A
authors.initials: JA
authors.lastname: Stafford
authors.forename: Susannah
authors.initials: S
authors.lastname: Eykyn
authors.forename: Gilbert
authors.initials: G
authors.lastname: Habib
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Mestres
authors.forename: Andrew
authors.initials: A
authors.lastname: Wang
mesh_terms: D004697:Endocarditis, Bacterial / Q000601:surgery*; D005260:Female; D006349:Heart Valve Diseases / Q000175:diagnosis* / Q000382:microbiology; D006801:Humans; D008297:Male; D008875:Middle Aged