Abstract 3708: The Use of Early Surgery in Definite Infective Endocarditis (IE): A Propensity Matched Analysis from 1622 Patients
Background: Early surgery has been shown to be beneficial for patients with IE, yet is not used in most patients. Wide variations exist in the use of cardiac surgery in IE with few defined indications for cardiac surgery. The aim of the study was to characterize patients with native valve IE and to determine if IE patients who benefit from an early surgical intervention can be identified.
Methods: The International Collaboration on Endocarditis Prospective Cohort Study was used to quantify the differences between patients with IE receiving medical and surgical intervention in 1622 patients with definite native valve IE. Propensity models were built to identify a group of patients that benefit from early surgery.
Results: Compared with the early medical group, patients in the early surgical group were more likely to be male, younger, have less comorbid conditions, and be infected with coagulase negative staphylococci ( P <0.01 for all). Intracardiac abscess and heart failure were more common in the surgical group ( P <0.001 for both). In an unadjusted comparison, there was a significant survival advantage during the initial hospitalization in the surgical group (87.0% vs. 79.2%, P<0.001). With the use of propensity modeling, 914 patients were matched based upon the likelihood of surgery with well matched groups. In this propensity matched cohort, the benefit of early surgery persisted in regards to in-hospital survival (87.5 vs. 78.1%, P<0.001).
Conclusions: In this large contemporary case series of prospectively-identified patients with definite native valve IE, patients that receive early surgery are clinically distinct than those who are managed with medical therapy alone. After adjustment for treatment bias with propensity analyses, early surgical therapy was associated with a significant survival advantage for patients with native valve IE