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Title: Infective Endocarditis: Surgical Management and Prognostic Predictors
Other Titles: Endocardite Infeciosa: Tratamento Cirúrgico e Preditores Prgnósticos
Author: Ilhão Moreira, R
Coutinho Cruz, M
Branco, LM
Galrinho, A
Coutinho Miranda, L
Fragata, J
Cruz Ferreira, R
Keywords: HSM CAR
Infective Endocarditis
Issue Date: May-2018
Publisher: Elsevier España
Citation: Rev Port Cardiol. 2018 May;37(5):387-394.
Abstract: INTRODUCTION AND AIM: Infective endocarditis (IE) is associated with high morbidity and mortality. It is important to determine which factors increase the risk of poor outcome in order to enable early detection and aggressive treatment, including surgery. The aim of our study was to identify factors predicting complications and in-hospital mortality in patients with IE and to analyze conditions predisposing to surgery and its outcome. METHODS: We performed a retrospective study including patients with IE who underwent transesophageal echocardiography in a tertiary hospital center (2006-2014). RESULTS: A total of 233 patients were analyzed (69.1% male; mean age 63.4±15.2 years; mean follow-up 28.4±30.7 months). The complication rate was 56.6% and in-hospital mortality was 16.3%. Independent predictors of mortality were chronic obstructive pulmonary disease (OR 4.89; CI 1.36-17.63; p=0.015), clinical course complicated by cerebral embolism (OR 9.38; CI 3.26-26.96; p<0.001), and IE due to Staphylococcus spp. (OR 3.78; CI 1.32-10.85; p=0.014) and non-HACEK Gram-negative bacilli (OR 12.85; CI 2.61-63.23; p=0.002). Surgery was performed in 36.9%. This group had higher percentages of males, younger patients, aortic valve IE, large vegetations, perivalvular extension, severe valvular regurgitation and heart failure. In patients with surgical indication (n=133), those who underwent surgery had lower in-hospital mortality (15.5% vs. 32.6%, p=0.028) and better long-term survival (log-rank p=0.029). CONCLUSION: The results of this study may help to identify IE patients who are at increased risk of worse outcome, offering the opportunity to change the course of the disease and to improve prognosis with earlier and more aggressive intervention.
Peer review: yes
DOI: 10.1016/j.repc.2017.08.007
Appears in Collections:CAR - Artigos
CCT - Artigos

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