Early valve surgery did not affect mortality in S. aureus endocarditis
Early valve surgery did not reduce 1-year mortality among patients with Staphylococcus aureus prosthetic valve infective endocarditis, according to recent study data.
“Consequently, we believe that decisions about early valve surgery [in these patients] should be individualized for each patient and based on careful clinical multidisciplinary evaluation, exactly as in other patients with infective endocarditis,” the researchers wrote in Clinical Infectious Diseases. “Further research to define the effect and optimize the timing of surgery in patients with S. aureus prosthetic valve infective endocarditis and more generally prosthetic valve infective endocarditis should in the future rely on well-designed multicenter interventional trials.”
Catherine Chirouze, MD, of Hôpital Jean Minjoz in Besançon, France, and colleagues examined data from the International Collaboration on Endocarditis – Prospective Cohort Study. There were 5,668 cases prospectively recorded from January 2000 to December 2006. The researchers excluded cases in IV drug users, cases of right-sided valve infective endocarditis or native valve infective endocarditis and cases with missing data. Among the 747 patients with left-sided prosthetic valve infective endocarditis (PVIE), 168 were due to S. aureus and underwent evaluation.
Patients who had early valve surgery (44.3%) showed lower 1-year mortality rate than patients who did not receive early valve surgery (33.8% vs. 59.1%; P=.001). However, the association did not persist in a multivariate, propensity-adjusted model (RR=0.67; 95% CI, 0.39-1.15). The researchers identified three variables associated with 1-year mortality: age (per 1-year increment, HR=1.03; 95% CI, 1.01-1.05), stroke (time-dependent HR=2.56; 95% CI, 1.62-4.05) and congestive heart failure (HR=2.06; 95% CI, 1.29-3.3).
“Although guidelines may help clinicians decide whether and when patients with infective endocarditis should undergo surgery, such decisions can be extremely difficult in individual and unique patients, and particularly in patients with PVIE,” the researchers wrote. “Patients with S. aureus PVIE who undergo early valve surgery are younger, have more severe cardiac complications and appear to have significantly lower in-hospital and 1-year mortality rates than patients with S. aureus PVIE who do not undergo early valve surgery. However, early valve surgery was not an independent predictor of better outcome.”
Disclosure: One researcher has received consulting honoraria or research grants from Abbott, Boehringer-Ingelheim, Bristol-Myers Squibb, Cubist, Novartis, GlaxoSmithKline, Gilead Sciences, Pfizer, Roche, Theravance and ViiV Healthcare.