title: Influence of early surgical treatment on the prognosis of left-sided infective endocarditis: a multicenter cohort study.
abstract: OBJECTIVE
  To analyze the influence of early valve operation on mortality in patients with left-sided infective endocarditis (IE).
  
  
  METHODS
  A multicenter cohort study was carried out between 1990 and 2010. Data from consecutive patients with definite IE and possible left-sided IE were collected. Propensity score matching and adjustment for survivor bias were used to control for confounders. The primary outcome was in-hospital mortality.
  
  
  RESULTS
  A total of 1019 patients with a mean age of 61 years (interquartile range, 47-71 years) were included. Early surgical treatment was performed in 417 episodes (40.9%). By propensity score, we matched 316 episodes: 158 who underwent early surgical treatment and 158 who did not (medical treatment group). In-hospital mortality and late mortality were lower in the surgically treated group (26.6% vs 41.8%; absolute risk reduction [ARR], -15.2%; P=.004 and 29.7% vs 46.2%; ARR, -16.5%; P=.002, respectively). Operation was independently associated with a lower risk of in-hospital mortality (odds ratio, 0.42; 95% CI, 0.22-0.79; P=.007). Operation was associated with reduced mortality in patients with paravalvular complications (ARR, -40.5%), severe heart failure (ARR, -32%), and native valve endocarditis (ARR, -17.8%).
  
  
  CONCLUSIONS
  This study supports the benefit of surgical treatment in patients with left-sided IE carried out during the initial phase of hospitalization, especially in patients with moderate or severe heart failure and paravalvular extension of infection.
authors.affiliation: Infectious Diseases and Clinical Microbiology Unit, University Hospital Virgen Macarena, Seville, Spain; Department of Medicine, University of Sevilla, Seville, Spain. Electronic address: jga@us.es.
authors.forename: Juan
authors.initials: J
authors.lastname: Gálvez-Acebal
authors.affiliation: Cardiology Service, University Hospital Virgen Macarena, Seville, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Almendro-Delia
authors.affiliation: Infectious Diseases and Microbiology Unit, University Hospital Virgen de la Victoria, Málaga, Spain.
authors.forename: Josefa
authors.initials: J
authors.lastname: Ruiz
authors.affiliation: Infectious Diseases, Microbiology and Preventive Medicine Unit, University Hospital Virgen del Rocío, Seville, Spain.
authors.forename: Arístides
authors.initials: A
authors.lastname: de Alarcón
authors.affiliation: Infectious Diseases Unit, Juan Ramón Jiménez Hospital, Huelva, Spain.
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Martínez-Marcos
authors.affiliation: Infectious Diseases Unit, Regional Hospital Carlos Haya, Málaga, Spain.
authors.forename: José M
authors.initials: JM
authors.lastname: Reguera
authors.affiliation: Infectious Diseases and Microbiology Unit, University Hospital Virgen de la Victoria, Málaga, Spain.
authors.forename: Radka
authors.initials: R
authors.lastname: Ivanova-Georgieva
authors.affiliation: Infectious Diseases Unit-Internal Medicine, Costal del Sol Hospital, Marbella, Spain.
authors.forename: Mariam
authors.initials: M
authors.lastname: Noureddine
authors.affiliation: Infectious Diseases Unit, Regional Hospital Carlos Haya, Málaga, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Plata
authors.affiliation: Infectious Diseases Unit, Juan Ramón Jiménez Hospital, Huelva, Spain.
authors.forename: José M
authors.initials: JM
authors.lastname: Lomas
authors.affiliation: Infectious Diseases Unit-Internal Medicine, Costal del Sol Hospital, Marbella, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: de la Torre-Lima
authors.affiliation: Infectious Diseases Unit, University Hospital Virgen de las Nieves, Granada, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Hidalgo-Tenorio
authors.affiliation: Infectious Diseases, Microbiology and Preventive Medicine Unit, University Hospital Virgen del Rocío, Seville, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Luque
authors.affiliation: Infectious Diseases and Clinical Microbiology Unit, University Hospital Virgen Macarena, Seville, Spain; Department of Medicine, University of Sevilla, Seville, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Rodríguez-Baño
mesh_terms: D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods*; D017548:Echocardiography, Transesophageal; D004696:Endocarditis / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome