title: Surgical management of infective endocarditis: early predictors of short-term morbidity and mortality.
abstract: BACKGROUND
  Infective endocarditis is a diagnostic and therapeutic challenge that ultimately requires surgical intervention in 20% of all cases. Early determinants of morbidity and mortality in this high risk population are not well described.
  
  
  METHODS
  The aim of this study was to determine preoperative clinical, microbiological, electrocardiographic, and echocardiographic variables that predicted the need for permanent pacemaker implantation and in-hospital death in a surgical cohort of patients with active infective endocarditis.
  
  
  RESULTS
  We identified 91 patients (61 males and 30 females, mean age 58 +/- 16 years) who underwent surgical intervention for active culture-positive infective endocarditis as defined by the Duke criteria. Native valve infective endocarditis was present in 78 (85.7%) and prosthetic valve endocarditis in 13 (14.3%) of cases. The aortic valve was infected in 61 (67.0%), the mitral in 35 (38.5%), and multiple valves in 8 patients (8.8%). The most common indication for surgical intervention was intractable heart failure. Twenty-two patients (24.2%) required pacemakers, while there were 14 (15.4%) in-hospital deaths. In age-adjusted and gender-adjusted analyses, the presence of left bundle branch block on preoperative electrocardiogram (ECG) and presence of depressed left ventricular systolic function (ejection fraction [EF] < 50%) predicted the need for a permanent pacemaker implantation, while the presence of depressed left ventricular function predicted in-hospital mortality.
  
  
  CONCLUSIONS
  Preoperative ECG findings of left bundle branch block and reduced left ventricular function may allow for early risk stratification of this high risk population.
authors.affiliation: Cardiac Ultrasound Laboratory, Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA. djassal@partners.org
authors.forename: Davinder S
authors.initials: DS
authors.lastname: Jassal
authors.forename: Tomas G
authors.initials: TG
authors.lastname: Neilan
authors.forename: Aruna D
authors.initials: AD
authors.lastname: Pradhan
authors.forename: Karen E
authors.initials: KE
authors.lastname: Lynch
authors.forename: Gus
authors.initials: G
authors.lastname: Vlahakes
authors.forename: Arvind K
authors.initials: AK
authors.lastname: Agnihotri
authors.forename: Michael H
authors.initials: MH
authors.lastname: Picard
mesh_terms: D000328:Adult; D000368:Aged; D002037:Bundle-Branch Block / Q000150:complications / Q000503:physiopathology; D004562:Electrocardiography; D004697:Endocarditis, Bacterial / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D013203:Staphylococcal Infections / Q000601:surgery; D013318:Stroke Volume; D016277:Ventricular Function, Left