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The association between the timing of valve surgery and 6-month mortality in left-sided infective endocarditis

I M Tleyjeh1, J M Steckelberg, G Georgescu

  • 1Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA. tleyjeh.imad@mayo.edu

Heart (British Cardiac Society)
|March 1, 2008
PubMed

Insights

For left-sided infective endocarditis (IE), delaying valve surgery beyond 11 days showed a protective trend against 6-month mortality. Multicollinearity issues may have impacted definitive conclusions on optimal surgical timing.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Surgical Outcomes

Background:

  • Left-sided infective endocarditis (IE) poses significant mortality risks.
  • The optimal timing for valve surgery in IE patients remains unclear.
  • Early surgical intervention is often favored, but evidence for its benefit is debated.

Purpose of the Study:

  • To investigate the association between the timing of valve surgery after IE diagnosis and 6-month mortality.
  • To determine if earlier surgery in left-sided IE correlates with improved survival outcomes.

Main Methods:

  • Retrospective cohort analysis of 546 patients with left-sided IE undergoing valve surgery within 30 days of diagnosis.
  • Cox proportional hazards modeling was used to assess the association between time from IE diagnosis to surgery and 6-month mortality.
  • Propensity score adjustment was employed to account for differences in early versus late surgical timing.

Main Results:

  • Of 129 patients who underwent surgery, 27.2% died within 6 months.
  • Univariate analysis indicated a protective effect of longer time to surgery (HR 0.93 per day, p=0.03).
  • Multivariate analysis showed a non-significant trend towards protection with longer time to surgery (aHR 0.97), potentially due to multicollinearity between time to surgery and propensity score (r=-0.63).

Conclusions:

  • While univariate analysis suggested a protective effect of delayed surgery, this significance was lost in multivariate analysis.
  • Multicollinearity between surgical timing and propensity score may have limited the ability to establish the independent effect of time to surgery.
  • Further research is needed to clarify the optimal surgical timing for left-sided IE to balance risks and benefits.
Abstract

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