Outcome after surgical treatment performed within the first week of antimicrobial therapy during infective endocarditis: a prospective study.
BACKGROUND
An increasing number of patients with infective endocarditis (IE) are operated on before the end of the first week of antimicrobial therapy. The mortality and morbidity of this specific group are unknown.


OBJECTIVE
To evaluate the outcome of patients with IE requiring cardiac surgery performed within the first week of antimicrobial therapy.


METHODS
All consecutive patients with a definite diagnosis of IE operated on within the first week of antimicrobial therapy were followed prospectively. Endpoints were in-hospital mortality and a combined endpoint of long-term cardiovascular death, recurrence and non-infective postoperative valvular dysfunction (PVD). The three main conditions requiring surgery, namely haemodynamic impairment, high embolic risk and periannular extension, were tested as potential predictors of outcome after adjustment for relevant variables.


RESULTS
Among the 95 patients included, surgery was performed a median time of 3 days after starting antimicrobial therapy. In-hospital mortality was 15%. The 3-year cumulative rates of the combined endpoint and of cardiovascular death were 38+/-7% and 27+/-7%, respectively. Recurrence occurred in 12% and PVD in 7%. Periannular extension was the main predictor of in-hospital death and the combined endpoint.


CONCLUSIONS
Despite the short time between starting antimicrobial therapy and performing surgery, the risk of death, recurrence and PVD does not appear excessively high. In the presence of periannular extension, however, surgery is associated with a greater risk of postoperative events.
Thuny
Franck
F
Department of Cardiology, La Timone Hospital, boulevard Jean-Moulin, 13005 Marseille, France.
Beurtheret
Sylvain
S
Gariboldi
Vlad
V
Mancini
Julien
J
Avierinos
Jean-François
JF
Riberi
Alberto
A
Casalta
Jean-Paul
JP
Gouriet
Frédérique
F
Tafanelli
Laurence
L
Giorgi
Roch
R
Collart
Frédéric
F
Raoult
Didier
D
Habib
Gilbert
G
D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000008:administration & dosage*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D003131:Combined Modality Therapy; D019992:Databases as Topic; D004334:Drug Administration Schedule; D004696:Endocarditis / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D012008:Recurrence; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome
D000890:Anti-Infective Agents