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Delaying valvular surgery showed no benefit in infective endocarditis
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Researchers observed no survival benefit when valvular surgery was delayed in a cohort of patients with infective endocarditis and stroke. They, therefore, recommend additional studies to examine pre- and postoperative data to allow more precise recommendations on the role of early surgery in this patient population.
Of the 857 patients included in the study, 58 patients underwent early surgical procedure and 140 had a delayed procedure. Early surgery was not significantly associated with increased in-hospital mortality (OR=2.308; 95% CI, 0.942-5.652).
Because the timing of cardiac surgery after stroke in patients with infective endocarditis remains controversial, researchers set out to examine the association between the timing of surgery after stroke and the incidence for in-hospital and 1-year follow-up mortality.
Data were pooled from the International Collaboration on Endocarditis–Prospective Cohort Study that included 4,794 patients with infective endocarditis between June 2000 and December 2006.
When compared with a 27.1% probability for death after 1-year follow-up among those in the early surgery group, the probability was 19.2% among those in the delayed surgery group (adjusted HR=1.138; 95% CI, 0.802-1.65).
No other differences in baseline demographic characteristics were observed other than causative microorganism. Staphylococcus aureus infective endocarditis was more common in those who underwent valve surgery within week 1 after neurologic symptom onset (48% vs. 32.1%; P=.036).
In addition, time to hospital admission was shorter among those assigned to the early surgery group.
“Our findings add credence to a growing body of literature suggesting that early cardiac surgery after ischemic stroke is not contraindicated and can be performed without delay with acceptable operative and longer-term survival when indications for surgery are present,” the researchers wrote.
Disclosure: The researchers report financial relationships with Abbott Vascular, American Physician, Anadys, Astellas, AstraZeneca, Boehringer Ingelheim, Bristol Myers-Squibb, Clinical Care Options, Cubist, Edwards Lifesciences, Gilead, GlaxoSmithKline, Hoffmann-La Roche, Janssen, Medtronic, Merck, MSD, Novartis, Pfizer, Pliva Pharmaceuticals, PolyMedix, Roche, Santaris, Springer, Tibotec, Trius and Vertex.
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