AUTHOR=Van Hemelrijck Mathias , Sromicki Juri , Frank Michelle , Greutmann Matthias , Ledergerber Bruno , Epprecht Jana , Padrutt Maria , Vogt Paul R. , Carrel Thierry P. , Dzemali Omer , Mestres Carlos-A. , Hasse Barbara TITLE=Dismal prognosis of patients with operative indication without surgical intervention in active left-sided infective endocarditis JOURNAL=Frontiers in Cardiovascular Medicine VOLUME=10 YEAR=2023 URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2023.1223878 DOI=10.3389/fcvm.2023.1223878 ISSN=2297-055X ABSTRACT=Introduction

Around 25% of patients with left-sided infective endocarditis and operative indication do not undergo surgery. Baseline characteristics and outcomes are underreported. This study describes characteristics and outcomes of surgical candidates with surgical intervention or medical treatment only.

Methods

Retrospective analysis of ongoing collected data from a single-center from an observational cohort of patients with infective endocarditis (ENVALVE). Kaplan-Meier estimates for survival was calculated. Factors associated with survival were assessed using a bivariable Cox model. To adjust for confounding by indication, uni- and multivariable logistic regression for the propensity to receive surgery were adjusted.

Results

From January 2018 and December 2021, 154 patients were analyzed: 116 underwent surgery and 38 received medical treatment only. Surgical candidates without surgery were older (70 vs. 62 years, p = 0.001). They had higher preoperative risk profile (EuroSCORE II 14% (7.2–28.6) vs. 5.8% (2.5–20.3), p = 0.002) and more comorbidities. One patient was lost-to-follow-up. Survival analysis revealed a significant higher one-year survival rate among patients following surgery (83.7% vs. 15.3% in the non-surgical group; log-rank test <0.0001). In the final multivariable adjusted model, surgery was less likely among patients with liver cirrhosis [OR = 0.03 (95% CI 0.00–0.30)] and with hemodialysis [OR = 0.014 (95% CI 0.00–0.47)].

Conclusion

Patients with left-sided infective endocarditis who do not undergo surgery despite an operative indication are older, have more comorbidities and therefore higher preoperative risk profile and a low 1-year survival. The role of the Endocarditis Team may be particularly important for the decision-making process in this specific group.