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Valvular surgery decreased mortality in infective endocarditis

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Valvular surgery during hospitalization for infective endocarditis was associated with significantly lower in-hospital and 1-year mortality compared with medical therapy alone.

Of 4,075 patients with infective endocarditis and a known heart failure status, 33.4% (95% CI, 31.9-34.8) had heart failure and 61.7% (95% CI, 59.2-64.3) had valvular surgery during index hospitalization.

“Approximately one-third of patients with endocarditis experience heart failure as a complication, which is typically advanced or severe in degree and due to acute valvular regurgitation,” Andrew Wang, MD, associate professor of medicine at Duke University Medical Center, told Endocrine Today. “We found that nearly two-thirds of patients with this complication undergo surgery during the initial hospitalization, and surgery is associated with lower mortality at 1 year. Therefore, heart failure severity is independently associated with use of cardiac surgery as well as mortality. “

For the prospective cohort study, Wang and colleagues assessed variables associated with in-hospital and 1-year mortality among 4,166 patients with infective endocarditis and heart failure across 61 centers in 28 countries between June 2000 and December 2006.

Results indicated in-hospital mortality was lower in patients who had valvular surgery (20.6%; 95%CI, 17.9-23.4) compared with medical therapy alone (44.8%; 95% CI, 40.4-49.0). Lower 1-year mortality was observed in patients who had valvular surgery (29.1%; 95% CI, 26.0-32.2) compared with those who did not (58.4%; 95% CI, 54.1- 62.6).

In addition, having diabetes, a health care–associated infection, causative microorganism, severe heart failure, stroke, paravalvular complications and advanced age were independently associated with 1-year mortality. Conversely, valvular surgery during the initial hospitalization was associated with lower mortality, according to the researchers.

“Patients with endocarditis and mild heart failure should be evaluated by a multi-disciplinary team of specialists for possible cardiac surgery,” Wang said. “Increased use of cardiac surgery for patients with this complication may lower the mortality rate in endocarditis.” – by Ashley DeNyse

For more information:

• Kiefer T. JAMA. 2011;306:2239-2247.

Disclosure: This work was supported in part by National Institutes of Health grant 2 T32 GM008600.

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