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Long-Term Outcome and Valve Surgery for Infective Endocarditis in the Systematic Analysis of a Community Study.
- Source :
-
The Annals of thoracic surgery [Ann Thorac Surg] 2016 Aug; Vol. 102 (2), pp. 496-504. Date of Electronic Publication: 2016 Apr 27. - Publication Year :
- 2016
-
Abstract
- Background: Information on the long-term prognosis of patients with infective endocarditis (IE) and valve surgical procedures is scarce, and most analyses are based on registries. This study described outcomes and predictors of mortality in a cohort of consecutive patients with IE with a long-term follow-up.<br />Methods: A total of 616 of patients with IE seen in an academic institution between 1990 and 2012 were identified and followed. The mean follow-up period was 4.8 ± 5.7 years (median, 2.6 years).<br />Results: Cardiac surgical procedures were performed in 47% of the patients, among whom 77% had surgical procedures in the first 6 months. Six-month and long-term (≥6 month) mortality rates were 15% and 40%, respectively. Older age, male sex, infection in a mechanical valve, Staphylococcus aureus infection, presence of vegetation, stroke, and atrioventricular block were independent predictors of mortality, whereas Streptococcus infection was independently associated with a better prognosis. Valve surgical procedures were independently associated with a decrease in mortality: hazard ratio (HR): 0.38; 95% confidence interval (CI): 0.26 to 0.56 for surgical treatment within 45 days; HR 0.36; 95% CI: 0.22 to 0.61 for surgical treatment between 45 and 180 days; and HR: 0.42; 95% CI: 0.25 to 0.73 for surgical treatment beyond 6 months. Decrease in mortality with valve surgical procedures was found in the two subgroups of patients with definite IE (adjusted HR: 0.36; 95% CI: 0.24 to 0.54; p < 0.0001) and in those with possible IE (HR: 0.40; 95% CI: 0.24 to 0.67; p = 0.0005).<br />Conclusions: In unselected patients with IE, prognostic factors for long-term mortality were consistent with those identified in previous studies for short-term mortality. These results confirm the apparent benefit associated with valve surgical procedures on long-term prognosis.<br /> (Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Aged
Echocardiography
Endocarditis diagnosis
Endocarditis mortality
Female
Follow-Up Studies
France epidemiology
Hospital Mortality trends
Humans
Male
Middle Aged
Prosthesis-Related Infections diagnosis
Prosthesis-Related Infections mortality
Retrospective Studies
Survival Rate trends
Time Factors
Endocarditis surgery
Heart Valve Diseases surgery
Heart Valve Prosthesis Implantation adverse effects
Prosthesis-Related Infections surgery
Registries
Subjects
Details
- Language :
- English
- ISSN :
- 1552-6259
- Volume :
- 102
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- The Annals of thoracic surgery
- Publication Type :
- Academic Journal
- Accession number :
- 27131900
- Full Text :
- https://doi.org/10.1016/j.athoracsur.2016.02.010