Early surgery for acute-onset infective endocarditis
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2018
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Oxford University Press
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Carlos Ferrera, Isidre Vilacosta, Cristina Fernández, Javier López, Cristina Sarriá, Carmen Olmos, Manuel Carnero-Alcázar, David Vivas, Salvatore Di Stefano, Carmen Sáez, Javier Cobiella, Daniel García-Arribas, Luis Carlos Maroto Castellanos, J Alberto San Román, Early surgery for acute-onset infective endocarditis, European Journal of Cardio-Thoracic Surgery, Volume 54, Issue 6, December 2018, Pages 1060–1066, https://doi.org/10.1093/ejcts/ezy208
Abstract
Objectives: Acute onset of infective endocarditis has been previously linked to the development of septic shock and a worse prognosis. The purpose of this study was to analyse the clinical features and in-hospital evolution of patients with acute-onset endocarditis as well as the potential role of early surgery in the treatment of these patients.
Methods: From 1996 to 2014, 1053 consecutive patients with left-sided endocarditis were prospectively included. Patients were classified into 2 groups according to the clinical presentation: patients with acute-onset endocarditis (n = 491) and patients with non-acute endocarditis (n = 562). Acute-onset endocarditis was considered when the time between the appearance of symptoms and diagnosis was <15 days.
Results: At admission, acute renal failure, septic shock and cerebral embolism predominated among patients with acute-onset endocarditis. Staphylococcus aureus was more frequently isolated in patients with an acute onset (27.7% vs 7.8% P < 0.001). During hospitalization, patients with acute onset developed systemic embolism and septic shock more frequently. Death was much more common in this group (42.7 vs 30.1%, P < 0.001). Paravalvular complications, nosocomial infection, heart failure, S. aureus and septic shock were predictors of mortality. Acute-onset presentation of endocarditis was strongly associated with increased mortality. Among patients with acute-onset endocarditis, early surgery, performed within the first 2 days after diagnosis, was associated with a 64% of reduction in mortality.
Conclusions: Patients with endocarditis and acute onset of symptoms are at high risk of septic in-hospital complications and mortality. Early surgery, performed within the first 2 days after diagnosis, plays a central role in the treatment of these patients.