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Surgery-first treatment improves clinical results in infective endocarditis complicated with disseminated

Junya Yokoyama1, Daisuke Yoshioka1, Koichi Toda1

  • 1Department of Cardiovascular Surgery, Osaka University Hospital, Osaka, Japan.

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|April 2, 2019
PubMed

Insights

Infective endocarditis (IE) with disseminated intravascular coagulation (DIC) has higher mortality and recurrence. Early valve surgery improves survival, while initial medical management leads to worse outcomes for IE patients with DIC.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Critical Care Medicine

Background:

  • Infective endocarditis (IE) is a severe infection often leading to sepsis and disseminated intravascular coagulation (DIC).
  • A definitive treatment strategy for IE complicated by DIC is lacking.
  • This study evaluates the prevalence, surgical outcomes, and optimal treatment strategy for IE with DIC.

Purpose of the Study:

  • To determine the prevalence of DIC in IE patients undergoing valve surgery.
  • To compare surgical outcomes and survival rates between patients with and without DIC.
  • To identify the optimal treatment strategy for IE patients with DIC.

Main Methods:

  • A cohort of 585 patients with active IE undergoing valve surgery between 2009 and 2017 was analyzed.
  • 116 patients (20%) had DIC. DIC patients were divided into medical treatment-first (Group M, n=45) and valve surgery-first (Group S, n=51) groups.
  • Patients with intracranial hemorrhage were excluded from the DIC group analysis.

Main Results:

  • Overall survival rates at 1 and 5 years were significantly lower in the DIC group (65%, 55%) compared to the non-DIC group (91%, 85%).
  • Recurrence-free survival was also lower in the DIC group (94%, 74%) versus the non-DIC group (99%, 95%).
  • Patients undergoing valve surgery first (Group S) had better 1 and 5-year survival rates (77%, 64%) than those initially treated medically (Group M: 51%, 46%). 'Medical treatment first' was an independent risk factor for mortality (HR 2.26).

Conclusions:

  • Mortality and IE recurrence are significantly higher in patients with DIC.
  • Delayed valve surgery in IE patients with DIC is associated with worse clinical outcomes.
  • Early valve surgery is recommended for IE patients with DIC to improve survival and reduce recurrence.
Abstract

Keywords:
Disseminated intravascular coagulationEndocarditisInfective endocarditisValve surgery

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