title: [The impact of early surgery on long-term outcome of patients with left-sided infective endocarditis].
abstract: OBJECTIVE
  This study aims to evaluate the impact of early surgery on long-term outcome of patients with left-sided native valve infective endocarditis (IE).
  
  
  METHODS
  Clinical data were retrospectively reviewed in 239 consecutive patients with left-sided native valve IE from 2002 to 2012 in Peking Union Medical College Hospital (PUMCH). Propensity score was used to match patients in the early operation and conventional treatment groups.
  
  
  RESULTS
  Early surgery was performed in 70 (29.3%) patients and the conventional treatment strategy was applied in 169 (70.7%) patients. The median follow-up period was 2 years. IE-related mortality was lower in the early operation group than in the conventional treatment group (10.0% vs 23.1%, P = 0.02). For 58 propensity score-matched pairs, the cumulative survival free from IE related death was significantly higher in the early operation group than in the conventional treatment group (P = 0.027). Regression analysis of the matched cohorts revealed that early surgery was independently associated with decreased IE-related mortality (HR 0.286; 95%CI 0.092-0.893; P = 0.031). While either cardiac function with NYHA Class III-IV (HR 4.044; 95%CI 1.318-12.407; P = 0.015) or uncontrolled infection (HR 52.064; 95%CI 10.996-247.194; P < 0.001) was associated with poor prognosis of increased mortality.
  
  
  CONCLUSIONS
  Early surgery improved long-term outcome in patients with left-sided native valve IE compared with conventional therapy. Risk factors related to increased mortality included heart failure and uncontrollable infection.
authors.affiliation: Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China. Email: shuyangzhang103@163.com.
authors.forename: Shuyang
authors.initials: S
authors.lastname: Zhang
authors.affiliation: Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
authors.forename: Zhuang
authors.initials: Z
authors.lastname: Tian
authors.affiliation: Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
authors.forename: Lilin
authors.initials: L
authors.lastname: Guo
mesh_terms: D004696:Endocarditis / Q000601:surgery*; D006333:Heart Failure; D006801:Humans; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome