Association Between Surgical Indications, Operative Risk, and Clinical Outcome in Infective Endocarditis

作者：Vivian H. Y. Chu, Lawrence P. Park, Eugene Athan, François Delahaye, Tomáš Freiberger, Cristiane da Cruz Lamas, José Maria Miró, Daniel W. Mudrick, Jacob Strahilevitz, Christophe Michel Tribouilloy, Emanuele Durante‐Mangoni, Juan Manuel Pericàs, Nuria Fernández‐Hidalgo, Francisco Nacinovich, Hussien Rizk, Vladimir Krajinović, Efthymia Giannitsioti, John P. Hurley, Margaret M. Hannan, Andrew Wang · 发表于：Circulation · 年份：2014 · DOI：10.1161/circulationaha.114.012461 · 被引用次数：280 · 研究领域：Infective Endocarditis Diagnosis and Management、Antibiotic Resistance in Bacteria、Actinomycetales infections and treatment

BACKGROUND: Use of surgery for the treatment of infective endocarditis (IE) as related to surgical indications and operative risk for mortality has not been well defined. METHODS AND RESULTS: The International Collaboration on Endocarditis-PLUS (ICE-PLUS) is a prospective cohort of consecutively enrolled patients with definite IE from 29 centers in 16 countries. We included patients from ICE-PLUS with definite left-sided, non-cardiac device-related IE who were enrolled between September 1, 2008, and December 31, 2012. A total of 1296 patients with left-sided IE were included. Surgical treatment was performed in 57% of the overall cohort and in 76% of patients with a surgical indication. Reasons for nonsurgical treatment included poor prognosis (33.7%), hemodynamic instability (19.8%), death before surgery (23.3%), stroke (22.7%), and sepsis (21%). Among patients with a surgical indication, surgical treatment was independently associated with the presence of severe aortic regurgitation, abscess, embolization before surgical treatment, and transfer from an outside hospital. Variables associated with nonsurgical treatment were a history of moderate/severe liver disease, stroke before surgical decision, and Staphyloccus aureus etiology. The integration of surgical indication, Society of Thoracic Surgeons IE score, and use of surgery was associated with 6-month survival in IE. CONCLUSIONS: Surgical decision making in IE is largely consistent with established guidelines, although n...