{"id":1179,"date":"2012-07-27T08:31:38","date_gmt":"2012-07-27T07:31:38","guid":{"rendered":"https:\/\/blogs.bmj.com\/heart-journalscan\/?p=1179"},"modified":"2015-11-12T16:04:41","modified_gmt":"2015-11-12T15:04:41","slug":"timing-of-surgery-for-endocarditis","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/heart\/2012\/07\/27\/timing-of-surgery-for-endocarditis\/","title":{"rendered":"Timing of surgery for endocarditis"},"content":{"rendered":"

Bacterial endocarditis continues to carry a substantial risk of death.\u00a0 Whilst surgical intervention in patients with incipient heart failure is recognised as efficacious, the timing and indications for surgical intervention to prevent systemic embolism remain controversial.\u00a0 In this small, single centre study Kang et al<\/em> compared the clinical outcome of early surgery versus conventional treatment with antibiotics and prospective future intervention.\u00a0 Recruiting a total of 76 patients with left-sided infective endocarditis, severe valve disease, and large vegetations (>10mm), patients were randomised in a 1:1 fashion either to early surgery (37) or conventional treatment (39) with the primary end point being\u00a0 a composite of in-hospital death and embolic events occurring within 6 weeks of randomization.\u00a0 Patients in the early-surgery group underwent valve surgery within 48 hours of randomization, whereas 30 patients (77%) in the conventional-treatment group underwent surgery during the initial hospitalization (27 patients) or during follow-up.\u00a0 The results highly favoured early surgical intervention with the primary end point occurring in 1 patient (3%) in the early-surgery group compared with 9 (23%) in the conventional-treatment group (HR, 0.10; 95% CI, 0.01 to 0.82; P=0.03).\u00a0 This was driven primarily by a reduction in embolic events with the composite end point of death from any cause, embolic events, or recurrence of infective endocarditis at 6 months being 3% in the early-surgery group and 28% in the conventional-treatment group (HR, 0.08; 95% CI, 0.01 to 0.65; P=0.02) but with no difference in all-cause mortality at 6 months(3% and 5%, respectively; HR, 0.51; 95% CI, 0.05 to 5.66; P=0.59).<\/p>\n

Conclusions<\/strong><\/p>\n

As compared with conventional treatment, early surgery in patients with infective endocarditis and large vegetations significantly reduced the composite end point of death from any cause and embolic events by effectively decreasing the risk of systemic embolism.<\/p>\n