Abstract 12754: The Association Between Surgical Indications, Operative Risk and Outcome in Infective Endocarditis
Introduction: The use of surgery in IE relative to indications and operative risk has not been well defined.
Objectives: 1) To evaluate the use of surgery in IE as related to indications and operative risk; 2) to analyze the association between surgical indications, operative risk, and 6-month survival.
Methods: The International Collaboration on Endocarditis-PLUS is a prospective registry involving 29 centers in 16 countries with 1296 patients with definite left-sided IE. Factors related to surgical decision making and Society of Thoracic Surgery (STS-IE) risk score were evaluated for relationship to surgical treatment and 6-month mortality.
Results: Patients had a median age of 62 years (25th, 75th %tile: 47, 72) and a substantial rate of medical comorbidities. A surgical indication was present in 74% of all patients; surgery was performed in 57% of the cohort and 76% of patients with an indication. The most common reason for lack of surgery among patients with a surgical indication was having a poor prognosis regardless of treatment (33.7%), hemodynamic instability (19.8%), death before surgery (23.3%), stroke (22.7%), and sepsis (21%). In multivariable analysis, surgical treatment was independently associated with the presence of severe aortic regurgitation, abscess, embolization, and transfer from an outside hospital. Variables associated with non-surgical treatment were a history of liver disease, stroke, and S. aureus etiology. The integration of surgical indication, operative risk score, and use of surgery was associated with 6-month survival in IE (figure).
Conclusions: Surgical decision-making in IE is largely consistent with established guidelines, although nearly one-quarter of patients with surgical indications do not undergo surgery. Operative risk assessment by STS-IE score provides prognostic information for survival beyond the operative period, and survival is higher among patients with indications who undergo surgery.
Author Disclosures: A. Wang: Research Grant; Significant; American Heart Association Mid Atlantic Affiliate Grant in Aid.
This research has received full or partial funding support from the American Heart Association.
- © 2014 by American Heart Association, Inc.