title: Cardiac surgery during the acute phase of infective endocarditis: discrepancies between European Society of Cardiology guidelines and practices.
abstract: OBJECTIVE
  Indications for surgery in acute infective endocarditis (IE) are detailed in guidelines, but their application is not well known. We analysed the agreement between the patient's attending physicians and European Society of Cardiology guidelines regarding indications for surgery. We also assessed whether surgery was performed in patients who had an indication.
  
  
  RESULTS
  From the 2008 prospective population-based French survey on IE, 303 patients with definite left-sided native IE were identified. For each case, we prospectively recorded (i) indication for surgery according to the attending physicians and (ii) indication for surgery according to guidelines. Surgery was indicated in 194 (65%) patients according to attending physicians and in 221 (73%) according to guidelines, while 139 (46%) underwent surgery. Agreement was moderate between attending physicians and guidelines (kappa 0.41-0.59) and between indication according to guidelines and the performance of surgery (kappa 0.38). Of the 90 (30%) patients not operated despite indication, contraindication to surgery was reported by the attending physicians in 42 (47%), and indication was not identified in 48 (53%). One-year survival was 76% in patients with indication and surgery performed (n = 131), 69% in patients without indication and no surgery (n = 74), 56% in patients with identified indication and contraindication to surgery (n = 42), and 60% in patients with no identified indication (n = 48; P = 0.059).
  
  
  CONCLUSIONS
  Cardiac surgery during acute IE was recommended in almost three out of four patients, although fewer than half were actually operated. Indication was not acknowledged by the attending physicians in one out of six patients.
authors.affiliation: Département de Cardiologie, AP-HP, Hôpital Bichat, Université Paris-Diderot, DHU Fire, 46 rue Henri Huchard, 75018 Paris, France bernard.iung@bch.aphp.fr.
authors.forename: Bernard
authors.initials: B
authors.lastname: Iung
authors.affiliation: Maladies Infectieuses et Tropicales, Hôpitaux Universitaires de Genève, Geneve, Switzerland.
authors.forename: Thanh
authors.initials: T
authors.lastname: Doco-Lecompte
authors.affiliation: Service de Chirurgie Cardiaque, Centre Hospitalier Universitaire, Besançon, France.
authors.forename: Sidney
authors.initials: S
authors.lastname: Chocron
authors.affiliation: Cabinet d'Infectiologie. Clinique Saint André-Groupe Courlancy, Reims, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Strady
authors.affiliation: Hôpital Louis Pradel, Hospices Civils de Lyon, Université Claude Bernard, Lyon, France.
authors.forename: François
authors.initials: F
authors.lastname: Delahaye
authors.affiliation: Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Régional Universitaire de Montpellier, Montpellier, France Unité Mixte de Recherche 145 Institut de Recherche sur le Développement/Université Montpellier 1, Montpellier, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Le Moing
authors.affiliation: AP-HP, Service de Bactériologie, Centre National de Référence des Streptocoques (CNR-Strep), Hôpital Cochin, Paris, France Institut Cochin, Université Paris Descartes, Faculté de médecine, CNRS (UMR 8104), Paris, France Inserm, U1016, Paris, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Poyart
authors.affiliation: EA 4003, Université de Nancy, Nancy, France Inserm CIC 007, Nancy, France.
authors.forename: François
authors.initials: F
authors.lastname: Alla
authors.affiliation: AP-HP, Hôpital Lariboisière, Service de Bactériologie, Paris, France Université Paris Diderot, Sorbonne Paris Cité, IAME UMR1137, Paris, France.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Cambau
authors.affiliation: Unité de Soins Intensifs et de Maladies Infectieuses, Hôpital Universitaire Pontchaillou, Rennes, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Tattevin
authors.affiliation: Maladies Infectieuses et Tropicales. Centre Hospitalier Universitaire, Besançon, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Chirouze
authors.affiliation: Hôpital Louis Pradel, Lyon, Chirurgie Cardiothoracique et Transplantation, Bron, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Obadia
authors.affiliation: AP-HP, Centre d'Investigation Clinique Inserm 1425, Hôpital Bichat, Université Paris-Diderot, Inserm U1137, Paris, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Duval
authors.affiliation: Université des Antilles et de la Guyane, Faculté de Médecine Hyacinthe Bastaraud, EA 4537, Pointe-à-Pitre, France Centre Hospitalier Universitaire de Pointe-à-Pitre, Inserm CIC1424, Service de Maladies Infectieuses et Tropicales, Dermatologie, Médecine Interne, Pointe-à-Pitre, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Hoen
mesh_terms: D000208:Acute Disease; D006348:Cardiac Surgical Procedures / Q000592:standards*; D000072096:Cardiologists / Q000592:standards*; D004617:Embolism / Q000517:prevention & control; D004697:Endocarditis, Bacterial / Q000601:surgery*; D005060:Europe; D005260:Female; D019983:Guideline Adherence / Q000592:standards; D006333:Heart Failure / Q000601:surgery; D006801:Humans; D008875:Middle Aged; D018579:Patient Selection; D017410:Practice Guidelines as Topic / Q000592:standards; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011247:Pregnancy; D011446:Prospective Studies; D012955:Societies, Medical
keywords: Endocarditis; Guidelines; Valvular surgery