title: Impact of early surgery on 6-month outcome in acute infective endocarditis.
abstract: BACKGROUND
  The mortality in acute infective endocarditis (IE) remains high. Data on results of early surgery are limited. The aim of our study was to determine whether early surgery is associated with reduced 6-month mortality in a large cohort of acute IE.
  
  
  RESULTS
  310 consecutive patients examined by transthoracic and transoesophageal echocardiography (229 males; mean age: 60+/-15) with definite IE according to Duke criteria were prospectively enrolled. Early surgery was performed in 106 (34%) patients (37 mechanical prosthesis, 32 biological prosthesis, 19 valve repairs, 15 pace maker line extractions, three multiple valve replacements) with an operative mortality of 5,7%. The mean time between admission and early surgery was 12+/-9 days. Early surgery was performed more frequently in patients with heart failure (48% vs 33%, p=0.009), uncontrolled infection (40% vs 23%; p=0.002), abscess (35% vs 18%; p=0.001), neurological event (34% vs 20%; p=0.005), embolic event (50% vs 34%; p=0.006), severe regurgitation (60% vs 29%; p=0.001) and large vegetation (>15 mm) (50% vs 23%; p<0.001). In unadjusted analysis, early surgery was associated with lower 6-month mortality (24% vs 37%; p=0.045). After adjustment of variables associated with mortality and comorbidity index, early surgery was identified as an independent predictor of reduced 6-month mortality (HR=0.52; IC 95%=0.2-0.9; p=0.025).
  
  
  CONCLUSIONS
  Early surgery performed in 34% of patients is independently associated with reduced mortality and should be considered in selected cases to improve outcome in acute IE.
authors.affiliation: Department of cardiovascular disease, INSERM, ERI-12, CHU Amiens, Avenue René Laënnec, 80054 Amiens, Cédex 1, France.
authors.forename: G
authors.initials: G
authors.lastname: Nadji
authors.forename: T
authors.initials: T
authors.lastname: Goissen
authors.forename: A
authors.initials: A
authors.lastname: Brahim
authors.forename: F
authors.initials: F
authors.lastname: Coviaux
authors.forename: N
authors.initials: N
authors.lastname: Lorgeron
authors.forename: C
authors.initials: C
authors.lastname: Tribouilloy
mesh_terms: D000208:Acute Disease; D015331:Cohort Studies; D004452:Echocardiography; D017548:Echocardiography, Transesophageal; D004696:Endocarditis / Q000000981:diagnostic imaging / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome