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Early surgery in infective endocarditis.

Artikel i vetenskaplig tidskrift
Författare Lars Olaison
Harriet Hogevik
A Oden
Kjell Alestig
Publicerad i QJM : monthly journal of the Association of Physicians
Volym 89
Nummer/häfte 4
Sidor 267-78
ISSN 1460-2725
Publiceringsår 1996
Publicerad vid Institutionen för invärtesmedicin, Avdelningen för infektionssjukdomar
Sidor 267-78
Språk en
Länkar dx.doi.org/10.1093/qjmed/89.4.267
www.ncbi.nlm.nih.gov/entrez/query.f...
Ämnesord Acute Disease, Death, Sudden, Cardiac, etiology, Endocarditis, Bacterial, complications, mortality, surgery, Female, Follow-Up Studies, Heart Valve Prosthesis, Humans, Male, Middle Aged, Multivariate Analysis, Prospective Studies, Risk Factors, Survival Analysis, Time Factors, Treatment Outcome
Ämneskategorier Infektionsmedicin, Thoraxkirurgi

Sammanfattning

Optimal timing of surgical intervention in infective endocarditis is important in reducing mortality. We prospectively studied 126 consecutive episodes of infective endocarditis treated in one institution over 5 years, with special emphasis on long-term results and on the effects on outcome of surgical interventions. Twenty-six patients (21%) underwent acute surgery on median treatment day 14. Mortality during treatment was 8% for patients undergoing acute surgery vs. 11% for those not undergoing surgery, and the adjusted 5-year survival rate of acute surgically treated patients was 91%, compared with 69% for the medically treated patients. Using univariate analysis, excess mortality during 5 years follow-up was associated with new cardiac decompensation at entry (p < 0.01), age (p < 0.01), no acute surgery (p < 0.05) and mitral valve involvement (p < 0.05). Multivariate analysis showed new cardiac decompensation at entry to be an independent predictor of cardiac death at 5 years follow-up (relative risk 2.39; CI 1.05-5.45), while no surgery during active disease implied a relative risk of 3.45, though not statistically significant. Patients undergoing surgery very early (< or = 10 days of treatment) did not have a poorer outcome. Acute valve replacement, as compared with medical therapy only, might be important to increase both short-term and long-term survival in infective endocarditis.

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