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Prognostic impact of cardiac surgery in left-sided infective endocarditis according to risk profile
Pablo Elpidio Garcia Granja1,2, Javier Lopez3,2, Isidre Vilacosta4
1Department of Cardiology, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario Valladolid, Valladolid, Spain pabloelpidio88@gmail.com.
Insights
Urgent cardiac surgery significantly improves survival for left-sided infective endocarditis (LSIE) patients with a surgical indication. The greatest benefits are observed in high-risk individuals and those with uncontrolled infection or heart failure.
Area of Science:
- Cardiology
- Infectious Diseases
- Surgical Outcomes
Background:
- Left-sided infective endocarditis (LSIE) is a serious condition requiring timely intervention.
- The role of urgent cardiac surgery in LSIE prognosis remains a critical area of investigation.
Purpose of the Study:
- To assess the prognostic impact of urgent cardiac surgery in patients with LSIE.
- To analyze the relationship between surgical benefit, patient baseline risk, and specific surgical indications.
Main Methods:
- A cohort of 605 patients with LSIE and a surgical indication were studied.
- Multivariable and propensity score analyses were employed to evaluate surgical outcomes.
- Patient risk was stratified using the ENDOVAL score.
Main Results:
- Urgent surgery independently predicted improved survival in LSIE patients (OR 0.260).
- The most significant survival benefit was observed in high-risk patients (predicted mortality 80%-100%).
- Surgery demonstrated remarkable benefit for uncontrolled infection and heart failure indications.
Conclusions:
- Urgent cardiac surgery during the active phase of LSIE substantially reduces in-hospital mortality.
- The prognostic improvement following surgery is directly correlated with the patient's baseline risk level.
Objective:
To evaluate the prognostic impact of urgent cardiac surgery on the prognosis of left-sided infective endocarditis (LSIE) and its relationship to the basal risk of the patient and to the surgical indication.
Methods:
605 patients with LSIE and formal surgical indication were consecutively recruited between 2000 and 2020 among three tertiary centres: 405 underwent surgery during the active phase of the disease and 200 did not despite having indication. The prognostic impact of urgent surgery was evaluated by multivariable analysis and propensity score analysis. We studied the benefit of surgery according to baseline mortality risk defined by the ENDOVAL score and according to surgical indication.
Results:
Surgery is an independent predictor of survival in LSIE with surgical indication both by multivariable analysis (OR 0.260, 95% CI 0.162 to 0.416) and propensity score (mortality 40% vs 66%, p<0.001). Its greatest prognostic benefit is seen in patients at highest risk (predicted mortality 80%-100%: OR 0.08, 95% CI 0.021 to 0.299). The benefit of surgery is especially remarkable for uncontrolled infection indication (OR 0.385, 95% CI 0.194 to 0.765), even in combination with heart failure (OR 0.220, 95% CI 0.077 to 0.632).
Conclusions:
Surgery during active LSIE seems to significantly reduce in-hospital mortality. The higher the risk, the higher the improvement in outcome.
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