The impact of early surgery on long-term outcome of patients with left-sided infective endocarditis
10.3760/cma.j.issn.0578-1426.2014.06.010
- VernacularTitle:早期手术对左心感染性心内膜炎长期预后的影响
- Author:
Hui WANG
;
Shuyang ZHANG
;
Zhuang TIAN
;
Lilin GUO
- Publication Type:Journal Article
- Keywords:
Endocarditis,bacterial;
Cardiac surgical procedures;
Prognosis
- From:
Chinese Journal of Internal Medicine
2014;53(6):450-454
- CountryChina
- Language:Chinese
-
Abstract:
Objective This study aims to evaluate the impact of early surgery on long-term outcome of patients with left-sided native valve infective endocarditis (IE).Methods Clinical data were retrospectively reviewed in 239 consecutive patients with left-sided native valve IE from 2002 to 2012 in Peking Union Medical College Hospital (PUMCH).Propensity score was used to match patients in the early operation and conventional treatment groups.Results Early surgery was performed in 70 (29.3％)patients and the conventional treatment strategy was applied in 169 (70.7％) patients.The median followup period was 2 years.IE-related mortality was lower in the early operation group than in the conventional treatment group (10.0％ vs 23.1％,P =0.02).For 58 propensity score-matched pairs,the cumulative survival free from IE related death was significantly higher in the early operation group than in the conventional treatment group (P =0.027).Regression analysis of the matched cohorts revealed that early surgery was independently associated with decreased IE-related mortality (HR 0.286 ; 95％ CI 0.092-0.893 ;P =0.031).While either cardiac function with NYHA Class Ⅲ-Ⅳ (HR 4.044; 95％ CI 1.318-12.407;P =0.015) or uncontrolled infection (HR 52.064; 95％ CI 10.996-247.194; P ＜ 0.001) was associated with poor prognosis of increased mortality.Conclusions Early surgery improved long-term outcome in patients with left-sided native valve IE compared with conventional therapy.Risk factors related to increased mortality included heart failure and uncontrollable infection.
