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Inicio Enfermedades Infecciosas y Microbiología Clínica (English Edition) Long-term prognosis after surgery for infective endocarditis: Distinction betwee...
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Vol. 37. Issue 7.
Pages 435-440 (August - September 2019)
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Vol. 37. Issue 7.
Pages 435-440 (August - September 2019)
Original article
DOI: 10.1016/j.eimce.2018.10.015
Long-term prognosis after surgery for infective endocarditis: Distinction between predictors of early and late survival
Pronóstico a largo plazo tras cirugía cardiaca en la endocarditis infecciosa: diferencias entre predictores de supervivencia precoz y tardía
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Laura Varela Barcaa,
Corresponding author
lauravarela21089@gmail.com

Corresponding author.
, Jose López-Menéndeza, Enrique Navas Elorzab, Jose Luis Moya Murc, Tomasa Centella Hernéndeza, Ana Redondo Palaciosa, Edmundo Ricardo Fajardoa, Javier Miguelena Hyckaa, Miren Martín Garcíaa, Rafael Muñoz Péreza, Jorge Rodríguez-Roda Stuarta
a Cardiac Surgery Department, Ramon y Cajal Hospital, Madrid, Spain
b Infectology Department, Ramon y Cajal Hospital, Madrid, Spain
c Cardiology Department, Ramon y Cajal Hospital, Madrid, Spain
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Figures (1)
Tables (3)
Table 1. Baseline patient characteristics.
Table 2. Univariate analysis of the risk factors associated with in-hospital mortality in the 180 patients who underwent cardiac surgery for active infective endocarditis.
Table 3. Univariate Cox analysis of the risk factors associated with long-term mortality in the 122 patients who survived the postoperative period after cardiac surgery for active infective endocarditis.
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Abstract
Objectives

Cardiac surgery is a life-saving procedure in patients diagnosed with infective endocarditis (IE). There are several validated risk scores developed to predict early-mortality; nevertheless, long-term survival has been less investigated. The aim of the present study is to analyze the impact of IE-specific risk factors for early and long-term mortality.

Methods

An observational retrospective study was conducted that included all patients who underwent surgery for IE from 2002 to 2016. Median follow-up time after surgery was 53.2 months (IQI 26.2–106.8 months). In-hospital mortality was analyzed using multiple logistic regression. Long-term survival was analyzed after one, two and five years. Cox proportional hazards regression was employed to identify risk factors related to long-term mortality.

Results

Of the 180 patients underwent cardiac surgery, 133 were discharged alive (in-hospital mortality was 26.11%). 6 variables were identified as independent factors associated with in-hospital mortality, most of them closely related to the severity of IE: age, multivalvular involvement, critical preoperative status, preoperative mechanical ventilation, abscess and thrombocytopenia.

Long-term survival in patients discharged alive was 89.1%, 87.4% and 77.6% after one, two and five years. Long-term mortality was independent of specific IE factors and 86.51% of deaths were not related to cardiovascular or infectious diseases.

Conclusion

Despite the high perioperative mortality rate after surgical treatment for active IE, long-term survival after hospital discharge was acceptable, regardless of the severity of the endocarditis episode. Although in-hospital survival depended mainly on several IE factors, long-term survival was not related to the severity of endocarditis baseline affection.

Keywords:
Infective endocarditis
Cardiac surgery
In-hospital mortality
Long-term survival
Resumen
Objetivos

La cirugía cardíaca es un procedimiento fundamental en pacientes diagnosticados de endocarditis infecciosa (EI). Existen varias escalas de riesgo para predecir la mortalidad temprana; sin embargo, la supervivencia a largo plazo ha sido menos estudiada. El objetivo es analizar el impacto de los factores de riesgo específicos de EI en la mortalidad temprana y a largo plazo.

Métodos

Estudio observacional retrospectivo que incluyó a todos los pacientes operados por EI entre 2002 y 2016. La mediana del tiempo de seguimiento fue de 53,2 meses (IQI: 26,2-106,8 meses). La mortalidad intrahospitalaria se analizó mediante regresión logística múltiple. La supervivencia se analizó a uno, 2 y 5 años. Los factores de riesgo de mortalidad tardía se analizaron mediante regresión de Cox.

Resultados

De los 180 pacientes operados, 133 sobrevivieron al postoperatorio inmediato (26,11% de mortalidad intrahospitalaria). Encontramos 6 factores asociados a la mortalidad hospitalaria: edad, afectación multivalvular, estado preoperatorio crítico, ventilación mecánica preoperatoria, absceso y trombopenia.

La supervivencia a largo plazo fue del 89,1, 87,4 y 77,6% después de uno, 2 y 5 años. La mortalidad a largo plazo fue independiente de factores específicos de la EI, y el 86,51% no se relacionó con enfermedades cardiovasculares o infecciosas.

Conclusión

A pesar de la alta tasa de mortalidad peri-operatoria tras cirugía, la supervivencia a largo plazo fue aceptable, independientemente de la gravedad del episodio de endocarditis. Aunque la supervivencia intrahospitalaria guardó relación con factores específicos de endocarditis, y la supervivencia a largo plazo no se correlacionó con la gravedad de la afectación inicial.

Palabras clave:
Endocarditis infecciosa
Cirugía cardiaca
Mortalidad intrahospitalaria
Supervivencia a largo plazo

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