1. Long-term prognosis after surgery for infective endocarditis: Distinction between predictors of early and late survival
- Author
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Miren Martín García, Enrique Navas Elorza, Jose López-Menéndez, Ana Redondo Palacios, Laura Varela Barca, Jorge Rodríguez-Roda Stuart, Javier Miguelena Hycka, Jose Luis Moya Mur, Edmundo Ricardo Fajardo, Tomasa Centella Hernéndez, and Rafael Muñoz Pérez
- Subjects
Microbiology (medical) ,Male ,medicine.medical_specialty ,Embolism ,Logistic regression ,Postoperative Complications ,Risk Factors ,Cause of Death ,medicine ,Endocarditis ,Humans ,Hospital Mortality ,Survivors ,Abscess ,Aged ,Proportional Hazards Models ,Retrospective Studies ,Aged, 80 and over ,Heart Failure ,business.industry ,Mortality rate ,Retrospective cohort study ,Perioperative ,Middle Aged ,medicine.disease ,Prognosis ,Shock, Septic ,Surgery ,Cardiac surgery ,Survival Rate ,Treatment Outcome ,Infective endocarditis ,Heart Valve Prosthesis ,Kidney Failure, Chronic ,Female ,Emergencies ,business ,Follow-Up Studies - Abstract
Objectives Cardiac surgery is a life-saving procedure in patients diagnosed with infective endocarditis (IE). There are several validated risk scores developed to predict early-mortality; nevertheless, long-term survival has been less investigated. The aim of the present study is to analyze the impact of IE-specific risk factors for early and long-term mortality. Methods An observational retrospective study was conducted that included all patients who underwent surgery for IE from 2002 to 2016. Median follow-up time after surgery was 53.2 months (IQI 26.2–106.8 months). In-hospital mortality was analyzed using multiple logistic regression. Long-term survival was analyzed after one, two and five years. Cox proportional hazards regression was employed to identify risk factors related to long-term mortality. Results Of the 180 patients underwent cardiac surgery, 133 were discharged alive (in-hospital mortality was 26.11%). 6 variables were identified as independent factors associated with in-hospital mortality, most of them closely related to the severity of IE: age, multivalvular involvement, critical preoperative status, preoperative mechanical ventilation, abscess and thrombocytopenia. Long-term survival in patients discharged alive was 89.1%, 87.4% and 77.6% after one, two and five years. Long-term mortality was independent of specific IE factors and 86.51% of deaths were not related to cardiovascular or infectious diseases. Conclusion Despite the high perioperative mortality rate after surgical treatment for active IE, long-term survival after hospital discharge was acceptable, regardless of the severity of the endocarditis episode. Although in-hospital survival depended mainly on several IE factors, long-term survival was not related to the severity of endocarditis baseline affection.
- Published
- 2019
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