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European Heart Journal Advance Access published online on October 10, 2006
European Heart Journal, doi:10.1093/eurheartj/ehl315
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European Heart Journal © The European Society of Cardiology 2006; all rights reserved
Received May 26, 2006
Revised September 20, 2006
Accepted September 28, 2006

Clinical research

Clinical and prognostic profile of patients with infective endocarditis who need urgent surgery

Ana Revilla 1 *, Javier López 1, Isidre Vilacosta 2, Eduardo Villacorta 1, María J. Rollán 3, José R. Echevarría 1, Yolanda Carrascal 1, Salvatore Di Stefano 1, Enrique Fulquet 1, Enrique Rodríguez 2, Luis Fiz 1, and José A. San Román 1

1 Department of Cardiology and Cardiac Surgery, Institute of Heart Sciences (ICICOR), Hospital Clínico Universitario, Ramón y Cajal 3-5, 47005 Valladolid, Spain
2 Department of Cardiology and Cardiac Surgery, Hospital Clínico San Carlos, Madrid, Spain
3 Department of Cardiology, Hospital Río Hortega, Valladolid, Spain

* To whom correspondence should be addressed.
Ana Revilla, E-mail: arevillaorodea{at}gmail.com


  Abstract

Aims Surgery in patients with infective endocarditis (IE) can be elective (upon completion of antibiotic treatment) or urgent (before antibiotic treatment has ended) when the clinical course is unfavourable. However, urgent surgery for left-sided endocarditis is associated with high mortality. The aims of this study were to describe the profile of patients with left-sided endocarditis who underwent urgent surgery and to analyse the factors that predicted mortality.

Methods and results Among 508 consecutive episodes of IE, 391 were left-sided and 89 required urgent surgery. The main reasons for urgent surgery were heart failure that did not respond to medication (72%) and persistent infection despite appropriate antibiotic treatment (31%). Thirty-two patients (36%) died during their hospital stay. Univariate analysis identified renal failure, septic shock, Gram-negative bacteria, persistent infection, and surgery for persistent infection as factors associated with mortality. Multivariate analysis confirmed only persistent infection and renal insufficiency as factors independently associated with a poor prognosis.

Conclusion Patients with IE who need urgent surgery have a poor clinical course. Heart failure, the main cause of urgent surgery, was not associated with higher mortality. However, persistent infection and renal failure were factors associated with higher post-surgical mortality.

Keywords: Endocarditis; Cardiac surgical procedures; Prognosis; Renal insufficiency; Congestive heart failure; Hospital mortality.
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