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Título
Clinical profile and prognosis of patients with left-sided infective endocarditis with surgical indication who are not operated
Autor
Año del Documento
2024
Editorial
MDPI
Descripción
Producción Científica
Documento Fuente
Microorganisms, 2024, Vol. 12, Nº. 3, 607
Resumen
Approximately a quarter of patients with infective endocarditis (IE) who have surgical indication only receive antibiotic treatment. Their short-term prognosis is dismal. We aimed to describe the characteristics of this group of patients to evaluate the mortality according to the cause of rejection and type of surgical indication and to analyze their prognostic factors of mortality. From 2005 to 2022, 1105 patients with definite left-sided IE were consecutively attended in three tertiary hospitals. Of them, 912 (82.5%) had formal surgical indication according to the most recent European Guidelines available in each period of the study and 303 (33%) only received medical treatment. These were older, had more comorbidities and higher in-hospital (46% vs. 24%; p < 0.001) and one year mortality (57.1% vs. 27.6%; p < 0.001) than operated patients. The main reason for surgical rejection was high surgical risk (57.1%) and the highest mortality when the cause were severe neurological conditions (76%). When the endocarditis team took the decision not to operate (25.5% of the patients), in-hospital (7%) and one-year mortality (17%) were low. In-hospital mortality associated with each surgical indication was 67% in heart failure, 53% in uncontrolled infection and 45% in prevention of embolisms (p < 0.001). Heart failure (OR: 2.26 CI95%: 1.29–3.96; p = 0.005), Staphylococcus aureus (OR: 3.17; CI95%: 1.72–5.86; p < 0.001) and persistent infection (OR: 5.07 CI95%: 2.85–9.03) are the independent risk factors of in-hospital mortality. One third of the patients with left-sided IE and formal surgical indication are rejected for surgery. In-hospital mortality is very high, especially when heart failure is the indication for surgery and when severe neurological conditions the reason for rejection. Short term prognosis of patients rejected by a specialized endocarditis team is favorable.
Materias (normalizadas)
Endocarditis
Cardiovascular system - Diseases
Cardiovascular, Aparato - Enfermedades
Cardiology
Surgery
Mortality
Mortalidad
Microbiology
Medicine
Public health
Materias Unesco
3205.01 Cardiología
3213 Cirugía
2414 Microbiología
32 Ciencias Médicas
3212 Salud Publica
ISSN
2076-2607
Revisión por pares
SI
Version del Editor
Propietario de los Derechos
© 2024 The authors
Idioma
eng
Tipo de versión
info:eu-repo/semantics/publishedVersion
Derechos
openAccess
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