title: Is delayed surgery related to worse outcomes in native left-sided endocarditis?
abstract: BACKGROUND
  Timing of surgery in the management of infective endocarditis is controversial, and there is still no definite conclusion on how early the surgery should be performed. This study focuses on the outcomes of surgery during the active period of infective endocarditis in consideration of the duration after diagnosis.
  
  
  METHODS
  One hundred and thirty-four patients with active native valve infective endocarditis who underwent surgery from January 2006 to December 2013 were reviewed retrospectively. They were divided in 2 groups based on timing of surgery: early group (first week after diagnosis, n = 37) and delayed group (2 to 6 weeks after diagnosis, n = 97).
  
  
  RESULTS
  Compared to the delayed group, the early group had significantly more patients in New York Heart Association class IV (81% vs. 43.3%), more mechanically ventilated (54.1% vs. 18.6%), more on inotropic support (62.2% vs. 38.1%), and hence a worse EuroSCORE II (14.8% vs. 8.8%). Operative mortality was comparable (5.4% vs. 10.3%) and 7-year survival was similar (77.4% vs. 74.6%). On multivariable regression analysis, delayed surgery did not impact on short- and long-term outcomes. Preoperative cardiac arrest and infection with Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, or Kingella were risk factors for higher operative mortality. Predictors of poor 7-year survival were diabetes mellitus and acute renal failure.
  
  
  CONCLUSIONS
  Delayed surgery is not associated with worse outcomes. Both early and delayed approaches are safe and provide acceptable results. Timing of surgery should be tailored to each patient's clinical status, not based on duration of endocarditis alone.
authors.affiliation: Cardiothoracic Division, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand ttepsuwan@yahoo.com.
authors.forename: Thitipong
authors.initials: T
authors.lastname: Tepsuwan
authors.affiliation: Cardiothoracic Division, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
authors.forename: Chartaroon
authors.initials: C
authors.lastname: Rimsukcharoenchai
authors.affiliation: Cardiothoracic Division, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
authors.forename: Apichat
authors.initials: A
authors.lastname: Tantraworasin
authors.affiliation: Cardiothoracic Division, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
authors.forename: Surin
authors.initials: S
authors.lastname: Woragidpoonpol
authors.affiliation: Cardiothoracic Division, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
authors.forename: Suphachai
authors.initials: S
authors.lastname: Schuarattanapong
authors.affiliation: Cardiothoracic Division, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
authors.forename: Weerachai
authors.initials: W
authors.lastname: Nawarawong
mesh_terms: D000328:Adult; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D004696:Endocarditis / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome
keywords: Cardiac surgical procedures; Endocarditis; Heart valve diseases; Risk assessment; Time factors; bacterial