title: Long-Term Outcome and Valve Surgery for Infective Endocarditis in the Systematic Analysis of a Community Study.
abstract: BACKGROUND
  Information on the long-term prognosis of patients with infective endocarditis (IE) and valve surgical procedures is scarce, and most analyses are based on registries. This study described outcomes and predictors of mortality in a cohort of consecutive patients with IE with a long-term follow-up.
  
  
  METHODS
  A total of 616 of patients with IE seen in an academic institution between 1990 and 2012 were identified and followed. The mean follow-up period was 4.8 ± 5.7 years (median, 2.6 years).
  
  
  RESULTS
  Cardiac surgical procedures were performed in 47% of the patients, among whom 77% had surgical procedures in the first 6 months. Six-month and long-term (≥6 month) mortality rates were 15% and 40%, respectively. Older age, male sex, infection in a mechanical valve, Staphylococcus aureus infection, presence of vegetation, stroke, and atrioventricular block were independent predictors of mortality, whereas Streptococcus infection was independently associated with a better prognosis. Valve surgical procedures were independently associated with a decrease in mortality: hazard ratio (HR): 0.38; 95% confidence interval (CI): 0.26 to 0.56 for surgical treatment within 45 days; HR 0.36; 95% CI: 0.22 to 0.61 for surgical treatment between 45 and 180 days; and HR: 0.42; 95% CI: 0.25 to 0.73 for surgical treatment beyond 6 months. Decrease in mortality with valve surgical procedures was found in the two subgroups of patients with definite IE (adjusted HR: 0.36; 95% CI: 0.24 to 0.54; p < 0.0001) and in those with possible IE (HR: 0.40; 95% CI: 0.24 to 0.67; p = 0.0005).
  
  
  CONCLUSIONS
  In unselected patients with IE, prognostic factors for long-term mortality were consistent with those identified in previous studies for short-term mortality. These results confirm the apparent benefit associated with valve surgical procedures on long-term prognosis.
authors.affiliation: Service de Cardiologie, Centre Hospitalier Universitaire Trousseau, Tours, France; Faculté de Médecine, Université François Rabelais, Tours, France.
authors.forename: Lauriane
authors.initials: L
authors.lastname: Pericart
authors.affiliation: Service de Cardiologie, Centre Hospitalier Universitaire Trousseau, Tours, France; Faculté de Médecine, Université François Rabelais, Tours, France. Electronic address: lfau@med.univ-tours.fr.
authors.forename: Laurent
authors.initials: L
authors.lastname: Fauchier
authors.affiliation: Faculté de Médecine, Université François Rabelais, Tours, France; Service de Chirurgie Cardiaque et Thoracique, Centre Hospitalier Universitaire Trousseau, Tours, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Bourguignon
authors.affiliation: Faculté de Médecine, Université François Rabelais, Tours, France; Service de Maladies Infectieuses, Centre Hospitalier Universitaire Bretonneau, Tours, France.
authors.forename: Louis
authors.initials: L
authors.lastname: Bernard
authors.affiliation: Service de Cardiologie, Centre Hospitalier Universitaire Trousseau, Tours, France; Faculté de Médecine, Université François Rabelais, Tours, France.
authors.forename: Denis
authors.initials: D
authors.lastname: Angoulvant
authors.affiliation: Service de Cardiologie, Hospices Civils de Lyon, Université Claude-Bernard Lyon I, Lyon, France.
authors.forename: François
authors.initials: F
authors.lastname: Delahaye
authors.affiliation: Service de Cardiologie, Centre Hospitalier Universitaire Trousseau, Tours, France; Faculté de Médecine, Université François Rabelais, Tours, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Babuty
authors.affiliation: Service de Cardiologie, Centre Hospitalier Universitaire Trousseau, Tours, France; Faculté de Médecine, Université François Rabelais, Tours, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Bernard
mesh_terms: D000368:Aged; D004452:Echocardiography; D004696:Endocarditis / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006349:Heart Valve Diseases / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors