Influence of Early Surgery on the Outcome of Infective Endocarditis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIUJian , WANGLi-min , YUMin ,  YUANZhong-xiang

Department of Cardiovascular Surgery, Shanghai First People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200080, P. R. China;

Corresponding author：

YUANZhong-xiang, Email: swalk0721@msn.com

Keywords：

Infective endocarditis; Early surgery; Conventional surgery

DOI：

10.7507/1007-4848.20150139

Video：

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Objective To study the relationship between the timing of surgery and one-year outcome in patients with infective endocarditis. Methods We retrospectively analyzed the clinical data of 97 patients suffered from leftside native valve infective endocarditis with neoplasm, admitted in Shanghai First People's Hospital between January 2000 and December 2011. There were 65 males and 32 females with mean age of 55.2±16.3 years (ranged 29 to 75 years). They were divided into two groups according to whether the surgery was performed within a week after diagnosis. The in-hospital mortality and one-year mortality, embolism and re-infection were calculated and compared between the two groups. Results There was no significant difference in the in-hospital mortality between the early surgery group and the conventional surgery group (1.9% versus 6.7%, P=0.241). While there was a significant difference in the rate of inhospital embolism related complications (1.9% versus 13.3%, P=0.030) between the two groups. There was no significant difference in one-year mortality between the two groups (1.9% versus 8.9%, P=0.122). The incidence rate of embolism related complication was 5.8% in the early surgery group and 20.0% in the conventional surgery group with a statistical difference (P=0.034). There was one patient with recurrent cerebral infarction among the 11 patients of cerebral infarction in the early surgery group,while 6 recurrent patients in the 9 patients with cerebral infarction in the conventional surgery group (9.1% versus 66.7%, P<0.005). Conclusions Early surgery in patients with left-side native valve infective endocarditis can't reduce the in-hospital mortality and one-year mortality but does decrease embolic events significantly. Early surgery is feasible in the patients with cerebral infarction.

Citation： LIUJian, WANGLi-min, YUMin, YUANZhong-xiang. Influence of Early Surgery on the Outcome of Infective Endocarditis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(6): 545-549. doi: 10.7507/1007-4848.20150139 Copy

1.	Fedeli U, Schievano E, Buonfrate D, et al. Increasing incidence and mortality of infective endocarditis: a population-based study through a record-linkage system. BMC Infect Dis, 2011, 11: 48-54.
2.	Horstkotte D, Follath F, Gutschik E, et al. Guidelines on prevention, diagnosis and treatment of infective endocarditis executive summary;the task force on infective endocarditis of the European society of cardiology. Eur Heart J, 2004, 25(3): 267-276.
3.	Mylonakis E, Calderwood SB. Infective endocarditis in adults. N Engl J Med, 2001, 345(18): 1318-1330.
4.	Prendergast BD, Tornos P. Surgery for infective endocarditis: who and when? Circulation, 2010, 121(9): 1141-1152.
5.	Moreillon P, Que YA. Infective endocarditis. Lancet, 2004, 363 (9403): 139-149.
6.	Tornos P, Iung B, Permanyer-MiraldaG, et al. Infective endocarditis in Europe: lessons from the Euro heart survey. Heart, 2005, 91(5):571-575.
7.	Delahaye F. Is early surgery beneficial in infective endocarditis? A systematic review. Arch Cardiovasc Dis, 2011, 104(1): 35-44.
8.	Li JS, Sexton DJ, Mick N, et al. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis,2000, 30(4): 633-638.
9.	Head SJ, Mokhles MM, Osnabrugge RL, et al. Surgery in current therapy for infective endocarditis. Vasc Heart Risk Manag, 2011, 7: 255-263.
10.	Bonow RO, Carabello BA, Chatterjee K, et al. 2008 focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1998 Guidelines for the Management of Patients with Valvular Heart Disease). Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol, 2008, 52(13): e1-e142.
11.	American College of Cardiology/American Heart Association Task Force on Practice Guidelines; Society of Cardiovascular Anesthesiologists; Society for Cardiovascular Angiography and Interventions; Society of Thoracic Surgeons, Bonow RO, Carabello BA, Kanu C, et al. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing committee to revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): developed in collaboration with the Society of Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. Circulation, 2006, 114(5): e84-e231.
12.	Thuny F, Di Salvo G, Belliard O, et al. Risk of embolism and death in infective endocarditis: prognostic value of echocardiography: a prospective multicenter study. Circulation, 2005, 112(1): 69-75.
13.	Habib G, Hoen B, Tornos P, et al. Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009): the task force on the prevention, diagnosis, and treatment of infective endocarditis of the European Society of Cardiology (ESC). Endorsed by the European society of Clinical Microbiology and Infectious Diseases (ESCMID) and the International Society of Chemotherapy (ISC) for infection and cancer. Eur Heart J, 2009, 30(19): 2369-2413.
14.	Haider K, Pinsky MR. Early surgery for native valve infective endocarditis. Crit Care, 2013, 17(1): 304-306.
15.	Kang DH, Kim YJ, Kim SH, et al. Early surgery versus conventional treatment for infective endocarditis. N Eng J Med, 2012, 366(26): 2466-2473.
16.	Fabri J Jr, Issa VS, Pomerantzeff PM, et al. Time-related distribution, risk factors and prognostic influence of embolism in patients with left-sided infective endocarditis. Int J Cardiol, 2006, 110(3): 334-339.
17.	Funakoshi S, Kaji S, Yamamuro A, et al. Impact of early surgery in the active phase on long-term outcomes in left-sided native valve infective endocarditis. J Thorac Cardiovasc Surg, 2011, 142(4): 836-842.
18.	Barsic B, Dickerman S, Krajinovic V, et al. Influence of the timing of cardiac surgery on the outcome of patients with infective endocarditis and stroke. Clin Infect Dis, 2013, 56(2): 209-217.
19.	Ruttmann E, Willeit J, Ulmer H, et al. Neurological outcome of septic cardio-embolic stroke after infective endocarditis. Stroke, 2006, 37(8): 2094-2099.

1. Fedeli U, Schievano E, Buonfrate D, et al. Increasing incidence and mortality of infective endocarditis: a population-based study through a record-linkage system. BMC Infect Dis, 2011, 11: 48-54.
2. Horstkotte D, Follath F, Gutschik E, et al. Guidelines on prevention, diagnosis and treatment of infective endocarditis executive summary;the task force on infective endocarditis of the European society of cardiology. Eur Heart J, 2004, 25(3): 267-276.
3. Mylonakis E, Calderwood SB. Infective endocarditis in adults. N Engl J Med, 2001, 345(18): 1318-1330.
4. Prendergast BD, Tornos P. Surgery for infective endocarditis: who and when? Circulation, 2010, 121(9): 1141-1152.
5. Moreillon P, Que YA. Infective endocarditis. Lancet, 2004, 363 (9403): 139-149.
6. Tornos P, Iung B, Permanyer-MiraldaG, et al. Infective endocarditis in Europe: lessons from the Euro heart survey. Heart, 2005, 91(5):571-575.
7. Delahaye F. Is early surgery beneficial in infective endocarditis? A systematic review. Arch Cardiovasc Dis, 2011, 104(1): 35-44.
8. Li JS, Sexton DJ, Mick N, et al. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis,2000, 30(4): 633-638.
9. Head SJ, Mokhles MM, Osnabrugge RL, et al. Surgery in current therapy for infective endocarditis. Vasc Heart Risk Manag, 2011, 7: 255-263.
10. Bonow RO, Carabello BA, Chatterjee K, et al. 2008 focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1998 Guidelines for the Management of Patients with Valvular Heart Disease). Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol, 2008, 52(13): e1-e142.
11. American College of Cardiology/American Heart Association Task Force on Practice Guidelines; Society of Cardiovascular Anesthesiologists; Society for Cardiovascular Angiography and Interventions; Society of Thoracic Surgeons, Bonow RO, Carabello BA, Kanu C, et al. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing committee to revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): developed in collaboration with the Society of Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. Circulation, 2006, 114(5): e84-e231.
12. Thuny F, Di Salvo G, Belliard O, et al. Risk of embolism and death in infective endocarditis: prognostic value of echocardiography: a prospective multicenter study. Circulation, 2005, 112(1): 69-75.
13. Habib G, Hoen B, Tornos P, et al. Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009): the task force on the prevention, diagnosis, and treatment of infective endocarditis of the European Society of Cardiology (ESC). Endorsed by the European society of Clinical Microbiology and Infectious Diseases (ESCMID) and the International Society of Chemotherapy (ISC) for infection and cancer. Eur Heart J, 2009, 30(19): 2369-2413.
14. Haider K, Pinsky MR. Early surgery for native valve infective endocarditis. Crit Care, 2013, 17(1): 304-306.
15. Kang DH, Kim YJ, Kim SH, et al. Early surgery versus conventional treatment for infective endocarditis. N Eng J Med, 2012, 366(26): 2466-2473.
16. Fabri J Jr, Issa VS, Pomerantzeff PM, et al. Time-related distribution, risk factors and prognostic influence of embolism in patients with left-sided infective endocarditis. Int J Cardiol, 2006, 110(3): 334-339.
17. Funakoshi S, Kaji S, Yamamuro A, et al. Impact of early surgery in the active phase on long-term outcomes in left-sided native valve infective endocarditis. J Thorac Cardiovasc Surg, 2011, 142(4): 836-842.
18. Barsic B, Dickerman S, Krajinovic V, et al. Influence of the timing of cardiac surgery on the outcome of patients with infective endocarditis and stroke. Clin Infect Dis, 2013, 56(2): 209-217.
19. Ruttmann E, Willeit J, Ulmer H, et al. Neurological outcome of septic cardio-embolic stroke after infective endocarditis. Stroke, 2006, 37(8): 2094-2099.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Influence of Early Surgery on the Outcome of Infective Endocarditis

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