The timing of surgery influences mortality and morbidity in adults with severe complicated infective endocarditis: a propensity analysis.
OBJECTIVE
To determine whether the timing of surgery could influence mortality and morbidity in adults with complicated infective endocarditis (IE).


RESULTS
In 291 consecutive adults with definite IE who underwent surgery during the active phase, we compared those operated on within the first week of antimicrobial therapy (n=95) to those operated on later (n=191). The impact of the timing of surgery on 6-month mortality, relapses, and postoperative valvular dysfunctions (PVD) was analysed using propensity score (PS) analyses. After stratification of the cohort into quintiles based on the PS, ≤1st week surgery was associated with a trend of decrease in 6-month mortality in the quintile of patients with the most likelihood of undergoing this early surgical management [quintile 5: 11% vs. 33%, odds ratio (OR)=0.18, 95% CI (confidence interval) 0.04-0.83, P=0.03]. Patients of this subgroup were younger, were more likely to have Staphylococcus aureus infections, congestive heart failure, and larger vegetations. Besides, ≤1st week surgery was associated with an increased number of relapses or PVD (16% vs. 4%, adjusted OR=2.9, 95% CI 0.99-8.40, P=0.05).


CONCLUSIONS
Surgery performed very early may improve survival in patients with the most severe complicated IE. However, a greater risk of relapses and PVD should be expected when surgery is performed very early.
Thuny
Franck
F
Department of Cardiology, La Timone Hospital, Boulevard Jean Moulin, 13005 Marseille, France.
Beurtheret
Sylvain
S
Mancini
Julien
J
Gariboldi
Vlad
V
Casalta
Jean-Paul
JP
Riberi
Alberto
A
Giorgi
Roch
R
Gouriet
Frédérique
F
Tafanelli
Laurence
L
Avierinos
Jean-François
JF
Renard
Sébastien
S
Collart
Frédéric
F
Raoult
Didier
D
Habib
Gilbert
G