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European Heart Journal Advance Access published online on March 26, 2009
European Heart Journal, doi:10.1093/eurheartj/ehp089
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

The timing of surgery influences mortality and morbidity in adults with severe complicated infective endocarditis: a propensity analysis

Franck Thuny1, Sylvain Beurtheret2, Julien Mancini3, Vlad Gariboldi2, Jean-Paul Casalta4, Alberto Riberi2, Roch Giorgi3, Frédérique Gouriet4, Laurence Tafanelli1, Jean-François Avierinos1, Sébastien Renard1, Frédéric Collart2, Didier Raoult4 and Gilbert Habib1,*

1 Department of Cardiology, La Timone Hospital, Boulevard Jean Moulin, 13005 Marseille, France
2 Department of Cardiothoracic Surgery, La Timone Hospital, Marseille, France
3 Department of Statistics, La Timone Hospital, Marseille, France
4 Department of Microbiology, La Timone Hospital, Marseille, France

Received 1 August 2008; revised 14 February 2009; accepted 18 February 2009 * Corresponding author. Tel: +33 4 91 38 75 88, Fax: +33 4 91 38 47 64, Email: gilbert.habib{at}free.fr

Aims: To determine whether the timing of surgery could influence mortality and morbidity in adults with complicated infective endocarditis (IE).

Methods and results: In 291 consecutive adults with definite IE who underwent surgery during the active phase, we compared those operated on within the first week of antimicrobial therapy (n = 95) to those operated on later (n = 191). The impact of the timing of surgery on 6-month mortality, relapses, and postoperative valvular dysfunctions (PVD) was analysed using propensity score (PS) analyses. After stratification of the cohort into quintiles based on the PS, ≤1st week surgery was associated with a trend of decrease in 6-month mortality in the quintile of patients with the most likelihood of undergoing this early surgical management [quintile 5: 11% vs. 33%, odds ratio (OR) = 0.18, 95% CI (confidence interval) 0.04–0.83, P = 0.03]. Patients of this subgroup were younger, were more likely to have Staphylococcus aureus infections, congestive heart failure, and larger vegetations. Besides, ≤1st week surgery was associated with an increased number of relapses or PVD (16% vs. 4%, adjusted OR = 2.9, 95% CI 0.99–8.40, P = 0.05).

Conclusion: Surgery performed very early may improve survival in patients with the most severe complicated IE. However, a greater risk of relapses and PVD should be expected when surgery is performed very early.

Key Words: Endocarditis • Surgery • Mortality • Prognosis


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