1. Impact of cardiac surgery on left-sided infective endocarditis with intermediate-length vegetations
- Author
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Valentina Scheggi, Yohann Bohbot, Christophe Tribouilloy, Faouzi Trojette, Chloé Di Lena, Mary Philip, Sandrine Hubert, Silvia Menale, Nicola Zoppetti, Stefano Del Pace, Pier Luigi Stefàno, Gilbert Habib, Niccolò Marchionni, Careggi University Hospital [Florence, Italie], CHU Amiens-Picardie, Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517 (MP3CV), Université de Picardie Jules Verne (UPJV)-CHU Amiens-Picardie, Unité de soins intensifs en chirurgie, Université de Picardie Jules Verne (UPJV), Assistance Publique - Hôpitaux de Marseille (APHM), Service de cardiologie, Université de la Méditerranée - Aix-Marseille 2-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital de la Timone [CHU - APHM] (TIMONE), Microbes évolution phylogénie et infections (MEPHI), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), and Unit of Gerontology and Geriatrics, Department of Critical Care Medicine and Surgery, University of
- Subjects
Endocarditis ,General Surgery ,Cardiology and Cardiovascular Medicine ,[SDV.MHEP]Life Sciences [q-bio]/Human health and pathology - Abstract
ObjectiveThe best strategy to manage patients with left-sided infective endocarditis (IE) and intermediate-length vegetations (10–15 mm) remains uncertain. We aimed to evaluate the role of surgery in patients with intermediate-length vegetations and no other European Society of Cardiology guidelines-approved surgical indication.MethodsWe retrospectively enrolled 638 consecutive patients admitted to three academic centres (Amiens, Marseille and Florence University Hospitals) between 2012 and 2022 for left-sided definite IE (native or prosthetic) with intermediate-length vegetations (10–15 mm). We compared four clinical groups: medically (n=50) or surgically (n=345) treated complicated IE, medically (n=194) or surgically (n=49) treated uncomplicated IE.ResultsMean age was 67±14 years. Women were 182 (28.6%). The rate of embolic events on admission was 40% in medically treated and 61% in surgically treated complicated IE, 31% in medically treated and 26% in surgically treated uncomplicated IE. The analysis of all-cause mortality showed the lowest 5-year survival rate for medically treated complicated IE (53.7%). We found a similar 5-year survival rate for surgically treated complicated IE (71.4%) and medically treated uncomplicated IE (68.4%). The highest 5-year survival rate was observed in surgically treated uncomplicated IE group (82.4%, log-rank pConclusionsOur results suggest that surgery is associated with lower all-cause mortality than medical therapy in patients with uncomplicated left-sided IE with intermediate-length vegetations even in the absence of other guideline-based indications.
- Published
- 2023
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