Effect of the type of surgical indication on mortality in patients with infective endocarditis who are rejected for surgical intervention
Por:
Ramos-Martinez, A, Calderon-Parra, J, Miro, JM, Farinas, MC, Goenaga, MA, Marcos, FJM, Vinuesa, D, Sanchez, FF, Noureddine, M, Rosas, G, Lima, JD, Aramendi, J, Blanco, MJ, Blanco, R, Boado, MV, Lazaro, MC, Crespo, A, Goikoetxea, J, Iruretagoyena, JR, Zuazabal, JI, Lopez-Soria, L, Montejo, M, Nieto, J, Rodrigo, D, Rodriguez, D, Rodriguez, R, Vitoria, Y, Voces, R, Lopez, MVG, Georgieva, RI, Ojeda, G, Bailon, IR, Morales, JR, Cuende, AM, Echeverria, T, Fuerte, A, Gaminde, E, Goenaga, MA, Idigoras, P, Iribarren, JA, Yarza, AI, Urkola, XK, Reviejo, C, Carrasco, R, Climent, V, Llamas, P, Merino, E, Plazas, J, Reus, S, Alvarez, N, Bravo-Ferrer, JM, Castelo, L, Cuenca, J, Llinares, P, Rey, EM, Mayo, MR, Sanchez, E, Regueiro, DS, Martinez, FJ, Alonso, MD, Castro, B, Rosado, DG, Duran, MD, Gomez, MAM, Lacalzada, J, Nassar, I, Ciezar, AP, Iglesias, JMR, Alvarez, VA, Costas, C, de la Hera, J, Suarez, JF, Fraile, LI, Arguero, VL, Menendez, JL, Bajo, PM, Morales, C, Torrico, AM, Palomo, C, Martinez, BP, Esteban, AR, Garcia, RR, Asensio, MT, Almela, M, Ambrosioni, J, Azqueta, M, Brunet, M, Bodro, M, Cartana, R, Falces, C, Fita, G, Fuster, D, de la Maria, CG, Hernandez-Meneses, M, Perez, JL, Marco, F, Miro, JM, Moreno, A, Nicolas, D, Ninot, S, Quintana, E, Pare, C, Pereda, D, Pericas, JM, Pomar, JL, Ramirez, J, Rovira, I, Sandoval, E, Sitges, M, Soy, D, Tellez, A, Tolosana, JM, Vidal, B, Vila, J, Adan, I, Bermejo, J, Bouza, E, Celemin, D, Caballero, GC, Montero, AD, Cruz, AF, Mansilla, AG, Leoni, MEG, Ramallo, VG, Hernandez, MK, Hualde, AM, Marin, M, Martinez-Selles, M, Menarguez, MC, Munoz, P, Rincon, C, Rodriguez-Abella, H, Rodriguez-Creixems, M, Pinilla, B, Pinto, A, Valerio, M, Vazquez, P, Moreno, EV, Antorrena, I, Loeches, B, Quiros, AM, Moreno, M, Ramirez, U, Baston, VR, Romero, M, Saldana, A, Balbin, JA, Castillo, CA, Arnaiz, A, de las Revillas, FA, Belaustegui, MC, Farinas, MC, Farinas-Alvarez, C, Izquierdo, RG, Garcia, I, Rico, CG, Gutierrez-Cuadra, M, Diez, JG, Pajaron, M, Parra, JA, Teira, R, Zarauza, J, Dominguez, F, Pavia, PG, Gonzalez, J, Orden, B, Ramos, A, Centella, T, Hermida, JM, Moya, JL, Martin-Davila, P, Navas, E, Oliva, E, del Rio, A, Ruiz, S, Tenorio, CH, Delia, MA, Araji, O, Barquero, JM, Jambrina, RC, de Cueto, M, Acebal, JG, Mendez, I, Morales, I, Lopez-Cortes, LE, de Alarcon, A, Garcia, E, Haro, JL, Lepe, JA, Lopez, F, Luque, R, Alonso, LJ, Azcarate, P, Gutierrez, JMA, Blanco, JR, Villegas, AC, Garcia-Alvarez, L, Oteo, JA, Sanz, M, de Benito, N, Gurgui, M, Pacho, C, Pericas, R, Pons, G, Alvarez, M, Fernandez, AL, Martinez, A, Prieto, A, Regueiro, B, Tijeira, E, Vega, M, Blasco, AC, Mollar, JC, Arana, JCG, Uriarte, OG, Lopez, AM, de Zarate, ZO, Matos, JAU, Gloria, GD, Antonio, SP, Leal, JMA, Vazquez, EG, Torres, AH, Blazquez, A, Valenzuela, GD, Alonso, A, Aramburu, J, Calvo, FE, Rodriguez, AM, Tarabini-Castellani, P, Galvez, EH, Bellido, CM, Pau, JL, Sepulveda, MA, Sierra, PT, Iqbal-Mirza, SZ, Alcolea, EC, Yanez, IK, Ballesta, AP, Escobar, EM, Monje, AP, Cabrera, VS, Garcia, DV, Asenjo, MA, Luna, CC, Morcillo, JN, Seco, MCP, Villoslada, A, Guallar, A, Abad, NF, Mangas, PG, Adell, MM, Ruiz, MPP, Porres, JC, Vidal, BA, Trigueros, NC, Espin, MJD, Caro, JAG, Sanchez, RJ, Almazan, AJ, Freire, AO, Gonzalez, MV, Ramis, PP, Blanco, MAR, Bordes, ERD, Bonet, LV, Munera, MCB, Garaizabal, EE, Martinez, AT, Luque, JCS
Publicada:
1 may 2019
Resumen:
Aim: To evaluate the effect of the type of surgical indication on mortality in infective endocarditis (IE) patients who are rejected for surgery.
Methods and results: From January 2008 to December 2016, 2714 patients with definite left-sided IE were attended in the participating hospitals. One thousand six hundred and fifty-three patients (60.9%) presented surgical indications. Five hundred and thirty-eight patients (32.5%) presented surgical indications but received medical treatment alone. The indications for surgery in these patients were uncontrolled infection (366 patients, 68%), heart failure (168 patients, 31.3%) and prevention of embolism (148 patients, 27.6%). One hundred and thirty patients (24.2%) presented more than one indication. The mortality during hospital admission was 60% (323 patients). The in-hospital mortality of patients whose indication for surgery was heart failure, uncontrolled infection or risk of embolism was 75.6%, 61.4% and 54.7%, respectively (p < 0.001). Surgical indications due to heart failure (OR: 3.24; CI 95%: 1.99-5.9) or uncontrolled infection (OR: 1.83; CI 95%: 1.04-3.18) were independently associated with a fatal outcome during hospital admission. Mortality during the first year was 75.4%. The mortality during the first year in patients whose indication for surgery was heart failure, uncontrolled infection or risk of embolism was 85.9%, 76.7% and 72.7%, respectively (p = 0.016). Surgical indication due to heart failure (OR: 3.03; CI 95%: 1.53-5.98) were independently associated with fatal outcome during the first year.
Conclusions: The type of surgical indication is associated with mortality in IE patients who are rejected for surgical intervention. (c) 2019 Elsevier B.V. All rights reserved.
Green Accepted
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