RT Journal Article
T1 Early surgery for acute-onset infective endocarditis
A1 Ferrera, Carlos
A1 Vilacosta, Isidre
A1 Fernández, Cristina
A1 López, Javier
A1 Sarriá, Cristina
A1 Olmos, Carmen
A1 Carnero Alcázar, Manuel
A1 Vivas Balcones, Luis David
A1 Di Stefano, Salvatore
A1 Sáez, Carmen
A1 Cobiella, Javier
A1 García Arribas, Daniel
A1 Maroto Castellanos, Luis Carlos
A1 San Román, José Alberto
AB 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.
PB Oxford University Press
SN 1010-7940
YR 2018
FD 2018-12-01
LK https://hdl.handle.net/20.500.14352/99803
UL https://hdl.handle.net/20.500.14352/99803
LA eng
NO 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
DS Docta Complutense
RD 22 ago 2024