Valvular Surgery Tied to Reduced Mortality in Endocarditis

Tied to lower in-hospital, one year mortality in infective endocarditis complicated by heart failure

TUESDAY, Nov. 22 (HealthDay News) -- For patients with infective endocarditis complicated by heart failure, valvular surgery is strongly associated with lower in-hospital and one-year mortality, according to a study published the Nov. 23/30 issue of the Journal of the American Medical Association.

Todd Kiefer, M.D., Ph.D., from the Duke University Medical Center in Durham, N.C., and colleagues investigated the clinical, echocardiographic, and microbiological variables associated with heart failure, and the variables independently correlated with in-hospital and one-year mortality, in 4,166 patients with definite native- or prosthetic-valve infective endocarditis. Of these, 4,075 patients had known heart failure status.

The investigators found that, of the patients with known heart failure status, 33.4 percent had heart failure. Of these patients with heart failure, 66.7 percent had severe heart failure (New York Heart Association class III or IV symptom status), and 61.7 percent underwent valvular surgery during the index hospitalization. There was a 29.7 percent in-hospital mortality rate in patients with heart failure. Patients undergoing valvular surgery had significantly lower mortality than those on medical therapy alone (20.6 versus 44.8 percent). One-year mortality was 29.1 and 58.4 percent in patients undergoing and not undergoing valvular surgery, respectively. After propensity score adjustment for surgery, one-year mortality had an independent correlation with advanced age, diabetes mellitus, health care-associated infection, causative microorganism, severe heart failure, stroke, and paravalvular complications. However, an association was seen for valvular surgery during the initial hospitalization and lower mortality.

"In-hospital and one-year mortality rates were high and were associated with heart failure severity, older age, paravalvular complications, diabetes mellitus, and stroke," the authors write.

Several authors disclosed financial ties to the pharmaceutical industry. One author served as a defense reviewer for an endocarditis-related legal case but did not testify.

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