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Effect of the Initial Strategy for Active Endocarditis Complicated With Acute Heart Failure
Ryohei Matsuura1, Daisuke Yoshioka1, Koichi Toda1
1Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine.
Circulation Journal : Official Journal of the Japanese Circulation Society
|September 11, 2018
Summary
Early surgery for infective endocarditis (IE) with acute heart failure (AHF) may improve survival. Patients undergoing immediate surgery had better outcomes than those initially treated with medication, especially with Staphylococcus aureus infections.
Area of Science:
- Cardiology
- Infectious Diseases
- Surgical Outcomes
Background:
- Infective endocarditis (IE) with acute heart failure (AHF) often necessitates early surgery, but clinical evidence is debated.
- Investigating the impact of initial treatment strategies in IE patients with AHF is crucial.
Purpose of the Study:
- To compare outcomes of immediate valvular surgery versus initial medical treatment for infective endocarditis (IE) patients presenting with acute heart failure (AHF).
- To identify risk factors for emergency surgery conversion in patients initially managed medically.
Main Methods:
- Retrospective review of 470 patients with active IE undergoing valvular surgery (2009-2016).
- Analysis of 177 patients with symptomatic AHF, divided into immediate surgery (Group S) and initial medical treatment (Group M).
- Comparison of 5-year survival rates and risk factors for emergency surgery.
Main Results:
- Immediate surgery (Group S) showed a trend towards higher 5-year survival (80%) compared to initial medical treatment (Group M, 64%).
- Within Group M, patients requiring emergency surgery (Group E, 42% survival) had significantly worse outcomes than those undergoing elective surgery (Group P, 79% survival).
- Staphylococcus aureus infection was a significant risk factor for conversion to emergency surgery in Group M (OR 3.82).
Conclusions:
- Early surgical intervention appears beneficial for infective endocarditis patients with acute heart failure.
- Medical management may lead to poorer outcomes if emergency surgery becomes necessary.
- Prompt surgical consideration is warranted, particularly in cases of Staphylococcus aureus infection.
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