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Reassessment of Vegetation Size as a Sole Indication for Surgery in Left-Sided Infective Endocarditis

Gonzalo Cabezón1, Javier López1, Isidre Vilacosta2

  • 1Instituto de Ciencias del Corazón, Hospital Clínico, Ciber de enfermedades cardiovasculares, Valladolid, Spain.

Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography
|December 31, 2021
PubMed

Insights

Surgery for large vegetations in left-sided infective endocarditis (LSIE) is not always beneficial. Large vegetations alone do not warrant surgery if other poor outcome predictors are absent.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Surgical Outcomes

Background:

  • Current guidelines suggest surgery for left-sided infective endocarditis (LSIE) with large vegetations.
  • The necessity of surgery based solely on large vegetation size, without other adverse factors, remains unclear.

Purpose of the Study:

  • To evaluate the impact of vegetation size on mortality in LSIE.
  • To determine if surgery improves outcomes in LSIE patients with large vegetations but no other indicators of poor prognosis.

Main Methods:

  • Analysis of 726 patients with definitive LSIE.
  • Multivariate analysis to identify mortality predictors.
  • Comparison of outcomes between patients with large (>10 mm) versus small (≤10 mm) vegetations.
  • Assessment of surgical impact on mortality in a subgroup without heart failure or uncontrolled infection.

Main Results:

  • Large vegetations were associated with increased mortality (31.7% vs 24.8%).
  • Factors predicting death included age, Staphylococcus aureus, perivalvular complications, heart failure, kidney failure, and septic shock; vegetation size was not an independent predictor.
  • In patients with large vegetations but no heart failure or uncontrolled infection, mortality rates were similar with or without surgery (18.6% vs 11.6%).

Conclusions:

  • While large vegetations indicate a poorer prognosis in LSIE, they alone are not a sufficient indication for surgery.
  • Surgery does not appear to improve outcomes for patients with large vegetations if they lack other significant predictors of poor prognosis.
  • These findings question the routine recommendation of surgery based solely on vegetation size in LSIE.
Abstract

Keywords:
Infective endocarditisLarge vegetationSurgeryVegetation size

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