The Association Between Surgical Indications, Operative Risk and Clinical Outcome in Infective Endocarditis: A Prospective Study From the International Collaboration on Endocarditis
Background—Use of surgery for the treatment of 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. 1,296 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 non-surgical 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 prior to surgical treatment, and transfer from an outside hospital. Variables associated with non-surgical treatment were a history of moderate/severe liver disease, stroke prior to surgical decision, and S. aureus etiology. The integration of surgical indication, STS-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 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. S. aureus IE was significantly associated with non-surgical management.
- risk assessment
- infective endocarditis
- Received July 28, 2014.
- Revision received September 29, 2014.
- Accepted October 17, 2014.