Timing of Surgery in InfecOve EndocardiOs

Transcription

“TimingofSurgeryinInfec0veEndocardi0s”
Lyon
CardiothoracicandVascularSurgeryDepartment
HôpitalLouisPradel
LYON-France
OBADIAJean-François
HVS-NewYork–17-18/03/2016 Downloadthispresenta0onon«chircardio-lyon.org»
Listofcompanies
AffiliaUon/Financial
RelaUonship
>Grant/ResearchSupport
Boeringher,SaintJudeMedical,Abbo6,Medtronic,
Edwards
>ConsulUngFees/Honoraria SaintJudeMedical
>MajorStockShareholder/
Equity
>RoyaltyIncome
Landanger,Delacroix-Chevalier
>Ownership/Founder
>IntellectualPropertyRights Landanger,Delacroix-Chevalier
>OtherFinancialBenefit
Medtronic,Sorin,Thoratec,AstraZeneca
MedtronicSymposiumSFCTCVMarseille11/06/2015 Downloadthispresenta0onon«chircardio-lyon.org»
INTRO
IndicaUonofsurgeryisoèndifficultinIEandTimingismorecomplex.
-Incidenceè50/million
-Mortalityè20%
-Surgeryè50%
Gudelines
Li_erature
Meta
Annalysis
Conclusion
INTRO
Guidelines
2004
Li_erature
Meta
Annalysis
Conclusion
ESC GUIDELINES
European Heart Journal (2009) 30, 2369–2413
doi:10.1093/eurheartj/ehp285
INTRO
Guidelines on the prevention, diagnosis,
and treatment of infective endocarditis
(new version 2009)
2009
The Task Force on the Prevention, Diagnosis, and Treatment of
Infective Endocarditis of the European Society of Cardiology (ESC)
Endorsed by the European Society of Clinical Microbiology and Infectious Diseases
(ESCMID) and by the International Society of Chemotherapy (ISC) for Infection and
Cancer
Authors/Task Force Members: Gilbert Habib (Chairperson) (France)*, Bruno Hoen (France), Pilar Tornos (Spain),
Franck Thuny (France), Bernard Prendergast (UK), Isidre Vilacosta (Spain), Philippe Moreillon (Switzerland),
Manuel de Jesus Antunes (Portugal), Ulf Thilen (Sweden), John Lekakis (Greece), Maria Lengyel (Hungary),
Ludwig Müller (Austria), Christoph K. Naber (Germany), Petros Nihoyannopoulos (UK), Anton Moritz (Germany),
Jose Luis Zamorano (Spain)
RECO
2009
ESC Committee for Practice Guidelines (CPG): Alec Vahanian (Chairperson) (France), Angelo Auricchio
(Switzerland), Jeroen Bax (The Netherlands), Claudio Ceconi (Italy), Veronica Dean (France), Gerasimos Filippatos
(Greece), Christian Funck-Brentano (France), Richard Hobbs (UK), Peter Kearney (Ireland), Theresa McDonagh
(UK), Keith McGregor (France), Bogdan A. Popescu (Romania), Zeljko Reiner (Croatia), Udo Sechtem (Germany),
Per Anton Sirnes (Norway), Michal Tendera (Poland), Panos Vardas (Greece), Petr Widimsky (Czech Republic)
Emergency<24h
Urgent<7j
Elec0veèhospit
Document Reviewers: Alec Vahanian (CPG Review Coordinator) (France), Rio Aguilar (Spain),
Maria Grazia Bongiorni (Italy), Michael Borger (Germany), Eric Butchart (UK), Nicolas Danchin (France),
Francois Delahaye (France), Raimund Erbel (Germany), Damian Franzen (Germany), Kate Gould (UK), Roger Hall
(UK), Christian Hassager (Denmark), Keld Kjeldsen (Denmark), Richard McManus (UK), José M. Miró (Spain),
Ales Mokracek (Czech Republic), Raphael Rosenhek (Austria), José A. San Román Calvar (Spain), Petar Seferovic
(Serbia), Christine Selton-Suty (France), Miguel Sousa Uva (Portugal), Rita Trinchero (Italy), Guy van Camp
(Belgium)
The disclosure forms of the authors and reviewers are available on the ESC website www.escardio.org/guidelines
Case1
* Corresponding author. Gilbert Habib, Service de Cardiologie, CHU La Timone, Bd Jean Moulin, 13005 Marseille, France. Tel: þ33 4 91 38 63 79, Email: [email protected]
The content of these European Society of Cardiology (ESC) Guidelines has been published for personal and educational use only. No commercial use is authorized. No part of the
ESC Guidelines may be translated or reproduced in any form without written permission from the ESC. Permission can be obtained upon submission of a written request to Oxford
University Press, the publisher of the European Heart Journal and the party authorized to handle such permissions on behalf of the ESC.
Disclaimer. The ESC Guidelines represent the views of the ESC and were arrived at after careful consideration of the available evidence at the time they were written. Health
professionals are encouraged to take them fully into account when exercising their clinical judgement. The guidelines do not, however, override the individual responsibility of health
professionals to make appropriate decisions in the circumstances of the individual patients, in consultation with that patient, and where appropriate and necessary the patient’s
guardian or carer. It is also the health professional’s responsibility to verify the rules and regulations applicable to drugs and devices at the time of prescription.
& The European Society of Cardiology 2009. All rights reserved. For permissions please email: [email protected].
Case2
Conclusion
European Heart Journal Advance Access published August 29, 2015
INTRO
ESC GUIDELINES
European Heart Journal
doi:10.1093/eurheartj/ehv319
2015 ESC Guidelines for the management
of infective endocarditis
The Task Force for the Management of Infective Endocarditis of the
European Society of Cardiology (ESC)
Authors/Task Force Members: Gilbert Habib* (Chairperson) (France),
Patrizio Lancellotti* (co-Chairperson) (Belgium), Manuel J. Antunes (Portugal),
Maria Grazia Bongiorni (Italy), Jean-Paul Casalta (France), Francesco Del Zotti (Italy),
Raluca Dulgheru (Belgium), Gebrine El Khoury (Belgium), Paola Anna Erbaa (Italy),
Bernard Iung (France), Jose M. Mirob (Spain), Barbara J. Mulder (The Netherlands),
Edyta Plonska-Gosciniak (Poland), Susanna Price (UK), Jolien Roos-Hesselink
(The Netherlands), Ulrika Snygg-Martin (Sweden), Franck Thuny (France),
Pilar Tornos Mas (Spain), Isidre Vilacosta (Spain), and Jose Luis Zamorano (Spain)
Guidelines
2015
Document Reviewers: Çetin Erol (CPG Review Coordinator) (Turkey), Petros Nihoyannopoulos (CPG Review
Coordinator) (UK), Victor Aboyans (France), Stefan Agewall (Norway), George Athanassopoulos (Greece),
Saide Aytekin (Turkey), Werner Benzer (Austria), Héctor Bueno (Spain), Lidewij Broekhuizen (The Netherlands),
Scipione Carerj (Italy), Bernard Cosyns (Belgium), Julie De Backer (Belgium), Michele De Bonis (Italy),
Konstantinos Dimopoulos (UK), Erwan Donal (France), Heinz Drexel (Austria), Frank Arnold Flachskampf (Sweden),
Roger Hall (UK), Sigrun Halvorsen (Norway), Bruno Hoenb (France), Paulus Kirchhof (UK/Germany),
* Corresponding authors: Gilbert Habib, Service de Cardiologie, C.H.U. De La Timone, Bd Jean Moulin, 13005 Marseille, France, Tel: +33 4 91 38 75 88, Fax: +33 4 91 38 47 64,
Email: [email protected]
Li_erature
Patrizio Lancellotti, University of Liège Hospital, GIGA Cardiovascular Sciences, Departments of Cardiology, Heart Valve Clinic, CHU Sart Tilman, Liège, Belgium – GVM Care and
Research, E.S. Health Science Foundation, Lugo (RA), Italy, Tel: +3243667196, Fax: +3243667194, Email: [email protected]
Downloaded from http://eurheartj.oxfordjournals.org/ by guest on September 4, 2015
Endorsed by: European Association for Cardio-Thoracic Surgery
(EACTS), the European Association of Nuclear Medicine (EANM)
ESC Committee for Practice Guidelines (CPG) and National Cardiac Societies document reviewers: listed in the Appendix
ESC entities having participated in the development of this document:
ESC Associations: Acute Cardiovascular Care Association (ACCA), European Association for Cardiovascular Prevention & Rehabilitation (EACPR), European Association of
Cardiovascular Imaging (EACVI), European Heart Rhythm Association (EHRA), Heart Failure Association (HFA).
ESC Councils: Council for Cardiology Practice (CCP), Council on Cardiovascular Nursing and Allied Professions (CCNAP), Council on Cardiovascular Primary Care (CCPC).
ESC Working Groups: Cardiovascular Pharmacotherapy, Cardiovascular Surgery, Grown-up Congenital Heart Disease, Myocardial and Pericardial Diseases, Pulmonary Circulation
and Right Ventricular Function, Thrombosis, Valvular Heart Disease.
The content of these European Society of Cardiology (ESC) Guidelines has been published for personal and educational use only. No commercial use is authorized. No part of the ESC
Guidelines may be translated or reproduced in any form without written permission from the ESC. Permission can be obtained upon submission of a written request to Oxford University Press, the publisher of the European Heart Journal and the party authorized to handle such permissions on behalf of the ESC.
Disclaimer. The ESC Guidelines represent the views of the ESC and were produced after careful consideration of the scientific and medical knowledge and the evidence available at
the time of their publication. The ESC is not responsible in the event of any contradiction, discrepancy and/or ambiguity between the ESC Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encouraged to take the ESC Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic or
therapeutic medical strategies; however, the ESC Guidelines do not override, in any way whatsoever, the individual responsibility of health professionals to make appropriate and
accurate decisions in consideration of each patient’s health condition and in consultation with that patient and, where appropriate and/or necessary, the patient’s caregiver. Nor
do the ESC Guidelines exempt health professionals from taking into full and careful consideration the relevant official updated recommendations or guidelines issued by the competent
public health authorities, in order to manage each patient’s case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations. It is also the
health professional’s responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription.
Meta
Annalysis
& The European Society of Cardiology 2015. All rights reserved. For permissions please email: [email protected].
Conclusion
Staphylococcaceae*
1991
1991
Journal of the1999
American College of Cardiology
305
62
331
63
23
51
1999
2008
2008
1991–1999–2008
90
339
122
975
27
72
43
186
274
93
© 2012 by the American College of Cardiology Foundation
Published by Elsevier Inc.
INTRO
1991–1999–2008
Prosthetic
valve
Temporal
Trends
Cerebral
1991 emboli
20.7
37.1
15.4
1.03
2.99
Vol. 59, No. 1.03
22,
2012
1.01–1.05
1.62–5.55
1.01–1.06
30.0 doi:10.1016/j.jacc.2012.02.029
3.88
21.2
1.04
Infective Endocarditis
35.2
3.53
19.1
1.03
2.09–7.18
1.02–1.06
2.06–6.05
1.02–1.04
33.9
2.41–4.68
in Infective Endocarditis
69
23
33.3
in the
Context
of
Prophylaxis
Guideline
Modifications
1991
43
14
32.6
ISSN 0735-1097/$36.00
3.36
2.45
1.34–4.49
2.25
1.04–4.83
58
13
22.4
1.79
0.88–3.62
19741999 Duval et al.
JACCVol.59,No.22,2012
Three
Successive Population-Based
1999
50SurveysEndocarditis
8
16.0
1.05
0.46–2.40
2008 Temporal Trends in Infective
84
20
23.8
1.22
0.68–2.19
2008
78
26
33.3
2.34
1.32–4.13
Xavier
Duval, MD, PHD,*†‡ François Delahaye,
MD, PHD,¶#
1991–1999–2008
211 MD, PHD,§!
56François Alla,26.5
1.76
1.23–2.52
Obadia, MD, PH48
D,†† Vincent Le28.1
Moing, MD, PHD,‡‡§§
Pierre1991–1999–2008
Tattevin, MD, PHD,** Jean-François
Guidelines
171
1.95
1.32–2.87
Staphylococcaceae*
Thanh Doco-Lecompte, MD,¶ Marie Celard, MD,!! Claire Poyart, MD, PHD,¶¶##*** JACC Vol. 59, No. 22, 2012
Cardiac1999,
surgery
May
2012:1968
Factors
(1991,
andPH2008)
With
In-Hospital
and62inChirouze,
the
Mortality
Survey
in Each
Population
of the
Surveys
Factors
Associated
WithPooled
In-Hospital
Mortality
in29,3Each
of–76the 3 Surveys
D,†††
Catherine
MD,‡‡‡
Bes,
PHD,!!
Christophe
Strady,
MD,
19912Associated
23 Michelle
37.1
2.99
1.62–5.55
Table
(1991,
and
the Pooled
HD,‡§§§ and
Bernard
Iung, MD,‡!!!
Christine
Selton-Suty,
MD,¶ Population
Emmanuelle
MD, P1999,
1991 Cambau,
94 2008)
21in
22.3 Survey
1.15
0.64–2.08
1999
90
27
30.0
3.88
2.09–7.18
11Million=24%pop>20y
Bruno Hoen, MD, PHD,‡‡‡¶¶¶ on behalf of the AEPEI Study Group
1999
166
17
10.2
0.44
0.23–0.82
2008
122 and Besançon,In-Hospital
43
35.2
3.53
2.06–6.05
Paris,
Lyon, Nancy, Rennes, Bron, Montpellier,
France
Death
Bivariate Regression
2008
168
30
17.9
0.67
0.39–1.13
1991–1999–2008
274
93
33.9
3.36
2.41–4.68
Li_erature
Objectives
evaluate temporal trends
in infective endocarditis
Factor The goal of this study was toN
n68
% (IE) incidence and clinical
Odds0.69
Ratio
95%
CI
1991–1999–2008
428
15.9
0.49–0.95
Cerebral embolicharacteristics after 2002 French IE prophylaxis guideline modifications.
Age
(yr) year † There are limited data on changes in the epidemiology of IE since recent guidelines recommended restricting
Survey
Background
1991
43
14
32.6
2.25
1.04–4.83
the indications of antibiotic prophylaxis of IE.
1991
305
63
20.7
1.03
1.01–1.05
1991
305
63
20.7
1.00
1999
1.05
0.46–2.40
Methods
Three 1-year population-based50
surveys were conducted 8
in 1991, 1999, and 16.0
2008 in 3 French regions totaling
11
million
inhabitants
age
!20
years.
We
prospectively
collected
IE
cases
from
all
medical
centers
and
ana1999
331
51
15.4
1.03
1.01–1.06
1999
331
51
15.4
0.70
0.47–1.05
2008
78IE annual incidence trends.
26
33.3
2.34
1.32–4.13
lyzed age- and sex-standardized
Meta
2008
339
72
21.2
1.04
1.02–1.06
2008
339
72
21.2
1.04
0.71–1.52
Annalysis
Results
Overall, 993 expert-validated IE cases were analyzed (323 in 1991; 331 in 1999; and 339 in 2008). IE incidence
1991–1999–2008
171
48
28.1
1.95
1.32–2.87
remained stable over time (95% confidence intervals given in parentheses/brackets): 35 (31 to 39), 33 (30 to
1991–1999–2008
975
186
19.1
1.03
1.02–1.04
37), and 32 (28 to 35) cases per million in 1991, 1999, and 2008, respectively. Oral streptococci IE incidence
Cardiac
surgery
Four
statistical
models
were
built,
1
for
each
of
the
3
surveys
and
the
last
one
for
the
pooled
population
of
975
patients.
The survey
did not increase either in the whole patient population (8.1 [6.4 to 10.1], 6.3 [4.8 to 8.1], and 6.3 [4.9 to 8.0] in
Prosthetic
valve
1991, 1999, and 2008,
or in patients
with pre-existing
native valve
disease. The increased incito nonsignificant
characteristics
in respectively)
the94
multivariate
regression
model.
*Staphylococcaceae
group includes Staphylococcus
31%
1991
21
22.3
1.15
0.64–2.08au
dence of Staphylococcus aureus IE (5.2 [3.9 to 6.8], 6.8 [5.3 to 8.6], and 8.2 [6.6 to 10.2]) was not significant in
1991 analyzedtheonly
23
33.3
2.45
1.34–4.49
†Variables
in the model 69
pooling the 3 surveys.
whole patient population (p ! 0.228) but was significant in the subgroup of patients without previously
1999
166 50%
17
10.2
0.44
0.23–0.82
known
native valve disease (1.6 [0.9 to 2.7], 3.7 [2.6 to 5.1], and 4.1 [3.0 to 5.6]; p ! 0.012).
CI " confidence
interval.
1999
58
13
22.4
1.79
0.88–3.62
2008
168 50%
30
17.9 incidence of oral strepto0.67
0.39–1.13
Conclusions
Scaling down antibiotic prophylaxis
indications was not
associated with an increased
Conclusion
2008
84of S. aureus bacteremia
20 in all patients, including
23.8those with no previously1.22
0.68–2.19
coccal IE. A focus on avoidance
known
1991–1999–2008
428
68 (J Am Coll Cardiol15.9
0.69
0.49–0.95
valve disease, will be required
to improve IE prevention.
2012;59:1968–76) © 2012 by
the
cocci.
Second,
1991–1999–2008
211Foundationdecrease
56
26.5 number 1.76
1.23–2.52
was
depicted
by
drastic
in
the
of
American
Collegea
of Cardiology
year
OBADIAJean-FrançoisSurvey
† HVS-NewYork–17-18/03/2016 Downloadthispresenta0onon«chircardio-lyon.org»
European Heart Journal Advance Access published December 18, 2015
CLINICAL RESEARCH
Valvular heart disease
INTRO
Cardiac surgery during the acute phase of infective
endocarditis: discrepancies between European
Society of Cardiology guidelines and practices
EuropheartJ2015
Universitaires de Genève, Geneve, Switzerland; Service de Chirurgie Cardiaque, Centre Hospitalier Universitaire, Besançon, France; Cabinet d’Infectiologie. Clinique Saint André1
2
3
4
Groupe Courlancy, Reims, France; 5Hôpital Louis Pradel, Hospices Civils de Lyon, Université Claude Bernard, Lyon, France; 6Service des Maladies Infectieuses et Tropicales, Centre
Hospitalier Régional Universitaire de Montpellier, Montpellier, France; 7Unité Mixte de Recherche 145 Institut de Recherche sur le Développement/Université Montpellier 1,
Montpellier, France; 8AP-HP, Service de Bactériologie, Centre National de Référence des Streptocoques (CNR-Strep), Hôpital Cochin, Paris, France; 9Institut Cochin, Université Paris
Descartes, Faculté de médecine, CNRS (UMR 8104), Paris, France; 10Inserm, U1016, Paris, France; 11EA 4003, Université de Nancy, Nancy, France; 12Inserm CIC 007, Nancy, France;
13
AP-HP, Hôpital Lariboisière, Service de Bactériologie, Paris, France; 14Université Paris Diderot, Sorbonne Paris Cité, IAME UMR1137, Paris, France; 15Unité de Soins Intensifs et de
Maladies Infectieuses, Hôpital Universitaire Pontchaillou, Rennes, France; 16Maladies Infectieuses et Tropicales. Centre Hospitalier Universitaire, Besançon, France; 17Hôpital Louis
Pradel, Lyon, Chirurgie Cardiothoracique et Transplantation, Bron, France; 18AP-HP, Centre d’Investigation Clinique Inserm 1425, Hôpital Bichat, Université Paris-Diderot, Inserm
U1137, Paris, France; 19Université des Antilles et de la Guyane, Faculté de Médecine Hyacinthe Bastaraud, EA 4537, Pointe-à-Pitre, France; and 20Centre Hospitalier Universitaire de
Pointe-à-Pitre, Inserm CIC1424, Service de Maladies Infectieuses et Tropicales, Dermatologie, Médecine Interne, Pointe-à-Pitre, France
Li_erature
ClassIorIIA
Received 17 July 2015; revised 17 September 2015; accepted 12 November 2015
Meta
Annalysis
Conclusion
Aims
Indications for surgery in acute infective endocarditis (IE) are detailed in guidelines, but their application is not well
known. We analysed the agreement between the patient’s attending physicians and European Society of Cardiology
guidelines regarding indications for surgery. We also assessed whether surgery was performed in patients who had
an indication.
.....................................................................................................................................................................................
Methods
From the 2008 prospective population-based French survey on IE, 303 patients with definite left-sided native IE were
and results
identified. For each case, we prospectively recorded (i) indication for surgery according to the attending physicians and
(ii) indication for surgery according to guidelines. Surgery was indicated in 194 (65%) patients according to attending
HeartFailure
physicians and in 221 (73%) according to guidelines, while 139 (46%) underwent surgery. Agreement was moderate
UncontrolledinfecFon
between attending physicians and guidelines (kappa 0.41 – 0.59) and between indication according to guidelines and
EmbolismprevenFon
the performance of surgery (kappa 0.38). Of the 90 (30%) patients not operated despite
indication, contraindication
to surgery was reported by the attending physicians in 42 (47%), and indication was not identified in 48 (53%). One-year
MedtronicSymposiumSFCTCVMarseille11/06/2015
HVS-NewYork–17-18/03/2016
B. Iung
Downloaded from http://eurheartj.oxfordjournals.org/ by guest on December 19, 2015
Bernard Iung 1*, Thanh Doco-Lecompte 2, Sidney Chocron 3, Christophe Strady 4,
5
Guidelines
Le Moing 6,7, Claire Poyart 8,9,10, François Alla 11,12,
Page 4 of 9 François Delahaye , Vincent
Emmanuelle Cambau 13,14, Pierre Tattevin 15, Catherine Chirouze 16,
Jean-François Obadia 17, Xavier Duval 18, and Bruno Hoen 19,20, on behalf of the
AEPEI Study Group†
2008prospecUveFrenchsurvey
Département de Cardiologie, AP-HP, Hôpital Bichat, Université Paris-Diderot, DHU
Fire, 46 rue Henri Huchard, 75018 Paris, France;
Maladies Infectieuses et Tropicales, Hôpitaux
Downloadthispresenta0onon«chircardio-lyon.org»
European Heart Journal Advance Access published December 18, 2015
CLINICAL RESEARCH
Valvular heart disease
INTRO
Cardiac surgery during the acute phase of infective
endocarditis: discrepancies between European
Society of Cardiology guidelines and practices
ac surgery during the acute phase of infective endocarditis
1
Département de Cardiologie, AP-HP, Hôpital Bichat, Université Paris-Diderot, DHU Fire, 46 rue Henri Huchard, 75018 Paris, France; 2Maladies Infectieuses et Tropicales, Hôpitaux
Universitaires de Genève, Geneve, Switzerland; 3Service de Chirurgie Cardiaque, Centre Hospitalier Universitaire, Besançon, France; 4Cabinet d’Infectiologie. Clinique Saint AndréGroupe Courlancy, Reims, France; 5Hôpital Louis Pradel, Hospices Civils de Lyon, Université Claude Bernard, Lyon, France; 6Service des Maladies Infectieuses et Tropicales, Centre
Hospitalier Régional Universitaire de Montpellier, Montpellier, France; 7Unité Mixte de Recherche 145 Institut de Recherche sur le Développement/Université Montpellier 1,
Montpellier, France; 8AP-HP, Service de Bactériologie, Centre National de Référence des Streptocoques (CNR-Strep), Hôpital Cochin, Paris, France; 9Institut Cochin, Université Paris
Descartes, Faculté de médecine, CNRS (UMR 8104), Paris, France; 10Inserm, U1016, Paris, France; 11EA 4003, Université de Nancy, Nancy, France; 12Inserm CIC 007, Nancy, France;
13
AP-HP, Hôpital Lariboisière, Service de Bactériologie, Paris, France; 14Université Paris Diderot, Sorbonne Paris Cité, IAME UMR1137, Paris, France; 15Unité de Soins Intensifs et de
Maladies Infectieuses, Hôpital Universitaire Pontchaillou, Rennes, France; 16Maladies Infectieuses et Tropicales. Centre Hospitalier Universitaire, Besançon, France; 17Hôpital Louis
Pradel, Lyon, Chirurgie Cardiothoracique et Transplantation, Bron, France; 18AP-HP, Centre d’Investigation Clinique Inserm 1425, Hôpital Bichat, Université Paris-Diderot, Inserm
U1137, Paris, France; 19Université des Antilles et de la Guyane, Faculté de Médecine Hyacinthe Bastaraud, EA 4537, Pointe-à-Pitre, France; and 20Centre Hospitalier Universitaire de
Pointe-à-Pitre, Inserm CIC1424, Service de Maladies Infectieuses et Tropicales, Dermatologie, Médecine Interne, Pointe-à-Pitre, France
Li_erature
Received 17 July 2015; revised 17 September 2015; accepted 12 November 2015
Meta
Annalysis
Aims
Conclusion
Downloaded from http://eurheartj.oxfordjournals.org/ by guest on December 19, 2015
2, Sidney Chocron 3, Christophe Strady 4,
EuropheartJ2015
Bernard Iung 1*, Thanh Doco-Lecompte
François Delahaye 5, Vincent Le Moing 6,7, Claire Poyart 8,9,10, François Alla 11,12,
Emmanuelle Cambau 13,14, Pierre Tattevin 15, Catherine
Chirouze 16,
IndicaUonrespected
Jean-François Obadia 17, Xavier Duval 18, and Bruno Hoen 19,20, on behalf of the
NoIndicaUonrespected
AEPEI Study Group†
Guidelines
Indications for surgery in acute infective endocarditis (IE) are detailed in guidelines, but their application is not well
known. We analysed the agreement between the patient’s attending physicians and European Society of Cardiology
guidelines regarding indications for surgery. We also assessed whether surgery was performed in patients who had
an indication.
.....................................................................................................................................................................................
Methods
From the 2008 prospective population-based French survey on IE, 303 patients with definite left-sided native IE were
and results
identified. For each case, we prospectively recorded (i) indication for surgery according to the attending physicians and
(ii) indication for surgery according to guidelines. Surgery was indicated in 194 (65%) patients according to attending
physicians and in 221 (73%) according to guidelines, while 139 (46%) underwent surgery. Agreement was moderate
between attending physicians and guidelines (kappa 0.41 – 0.59) and between indication according to guidelines and
the performance of surgery (kappa 0.38). Of the
not operated despite indication, contraindication
90 (30%)
patients
CLINICAL RESEARCH
Endocarditis
INTRO
The timing of surgery influences mortality and
morbidity in adults with severe complicated
infective endocarditis: a propensity analysis
Franck Thuny 1, Sylvain Beurtheret 2, Julien Mancini 3, Vlad Gariboldi 2,
Jean-Paul Casalta 4, Alberto Riberi 2, Roch Giorgi 3, Frédérique Gouriet 4,
Laurence Tafanelli1, Jean-François Avierinos 1, Sébastien Renard 1, Frédéric Collart 2,
Didier Raoult 4, and Gilbert Habib 1* EHJ 2009
Guidelines
1
Department of Cardiology, La Timone Hospital, Boulevard Jean Moulin, 13005 Marseille, France; 2Department of Cardiothoracic Surgery, La Timone Hospital, Marseille, France;
Department of Statistics, La Timone Hospital, Marseille, France; and 4Department of Microbiology, La Timone Hospital, Marseille, France
3
Received 1 August 2008; revised 14 February 2009; accepted 18 February 2009; online publish-ahead-of-print 26 March 2009
To determine whether the timing of surgery could influence mortality and morbidity in adults with complicated infective endocarditis (IE).
.....................................................................................................................................................................................
Methods
In 291 consecutive adults with definite IE who underwent surgery during the active phase, we compared those operand results
ated on within the first week of antimicrobial therapy (n ¼ 95) to those operated on later (n ¼ 191). The impact of
the timing of surgery on 6-month mortality, relapses, and postoperative valvular dysfunctions (PVD) was analysed
using propensity score (PS) analyses. After stratification of the cohort into quintiles based on the PS, !1st week
surgery was associated with a trend of decrease in 6-month mortality in the quintile of patients with the most likelihood of undergoing this early surgical management [quintile 5: 11% vs. 33%, odds ratio (OR) ¼ 0.18, 95% CI (confidence interval) 0.04 –0.83, P ¼ 0.03]. Patients of this subgroup were younger, were more likely to have
Staphylococcus aureus infections, congestive heart failure, and larger vegetations. Besides, !1st week surgery was
associated with an increased number of relapses or PVD (16% vs. 4%, adjusted OR ¼ 2.9, 95% CI 0.99 –8.40,
P ¼ 0.05).
.....................................................................................................................................................................................
Conclusion
Surgery performed very early may improve survival in patients with the most severe complicated IE. However, a
greater risk of relapses and PVD should be expected when surgery is performed very early.
Early surgery
< 7 days
291
(55 %)
Meta
Annalysis
95
243
(45 %)
(33 %)
Downloaded from eurheartj.oxfordjournals.org at ESC Member on August 23, 2011
Aims
Li_erature
> 7 days
196
(67 %)
----------------------------------------------------------------------------------------------------------------------------------------------------------Keywords
Medical therapy
Conclusion
Endocarditis † Surgery † Mortality † Prognosis
Introduction
The number of patients operated on during the active phase of
infective
endocarditis (IE) has increased during the last decade
physicians to offer surgical treatment to an increasing number of
patients. However, not only does the effect of surgery not seem
8 – 10
to
but uncertainties remain about
be uniform
in all patients,
Others
No microorganism identified
Streptococcus bovis
Enterococci
Values are expressed as number (%).
Others
INTRO
No microorganism identified
14 (15)
32 (16)
1113
(12)(14)
25 (13)
39 (20)
12 (13)
14 (15)
CLINICAL RESEARCH
21 (11)
32 (16)
Endocarditis
25 (13)
11 (12)
0.21
Table
3surgery
Outcome ofinfluences
the 291 patients with
infective
Thearetiming
of
mortality
Values
expressed
as
number
(%).
endocarditis operated during antimicrobial therapy
and
>1st week analysis
P-value
infective endocarditis:!1st
a week
propensity
surgery group surgery group
3, Vlad Gariboldi 2,
Franck Thuny 1, Sylvain Beurtheret 2, (n
Julien
5 95)Mancini(n
5 196)
4
2
3
, Alberto Riberi , Roch Giorgi , Frédérique Gouriet 4,
Jean-Paul Casalta ................................................................................
1, Jean-François Avierinos 1, Sébastien Renard 1, Frédéric Collart 2,
Laurence Tafanelli6-month
mortality
14 (15)
23 (12)
0.47
4
Didier Raoult , and Gilbert Habib 1*
Guidelines
Table 3 Outcome of the 291 patients with infective
EuropHeartJ:2011:32,2027–2033
and
15 (16) antimicrobial
7 (4)
0.0005
endocarditis Relapses
operated
during
therapy
1
3
postoperative
valvular
>1st week
P-value
dysfunction!1st week
To determine whether the timing of surgery could influence mortality and morbidity in adults with complicated infecRelapses surgery8group
(8)
4 (2)
0.02
surgery
group
tive endocarditis (IE).
Li_erature
.....................................................................................................................................................................................
Methods
surgery was associated with a trend of decrease in 6-month mortality in the quintile of patients with the most likeValues
are expressed
number
(%). [quintile 5: 11% vs. 33%, odds ratio (OR) ¼ 0.18, 95% CI (conlihood
of undergoing
this earlyas
surgical
management
fidence interval) 0.04 –0.83, P ¼ 0.03]. Patients of this subgroup were younger, were more likely to have
P ¼ 0.05).
.....................................................................................................................................................................................
Conclusion
Postoperative(n
valvular
(2) 196) 0.02
5 95)7 (7)
(n35
dysfunction
................................................................................
6-month mortality
Meta
Annalysis
14 (15)
23 (12)
0.47
Aims
Relapses and
15 (16)
7 (4)
0.0005
postoperative
Figure 1 Six-month mortality according to propensity subgroups (Q ¼ quintile). *In quintile 5, !1st week surgery was
valvular
abscess in one patient, and unknown in one patient. After adjustwith reduced 6-month mortality (odds ratio ¼ 0.18;
- - - - dysfunction
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -associated
Keywords
Endocarditis
† Surgery
† Mortalityno
† Prognosis
ment for
PS quintiles,
significant effect of !1st week surgery
95% CI 0.04–0.83; P ¼ 0.03). ValuesYoung
are expressed as number (%).
Relapses
8
(8)
4
(2)
0.02
16%
was observed on 6-month mortality in the entire cohort [15%
StaphAureus
12%, adjusted7 odds
95% CI 0.55–3.06,
Postoperativevs.valvular
(7) ratio (OR) ¼ 1.3,
3 (2)
0.02
HeartFailure
Introduction P ¼ 0.55] as well as when the timing of surgery was tested as a
surgery
was
observed
from
the
quintile 2 to the quintile 5
physicians
to
offer
surgical
treatment
to
an
increasing
number
of
dysfunction
Largeveget
The number of patients operated on during the active phase of
patients. However, not only does the effect of surgery not seem
(Table 4).
variable
(adjusted
OR
1.0, in95%
CI 0.98–1.02,
P ¼ remain about
infective endocarditis (IE)continuous
has increased during
the last
decade
to be¼
uniform
all patients,
but uncertainties
and ranges from 30% to 60%. Recent
changes in the epidemiothe optimal timing of the operation. Although the indications for
4%
In comparison with the other subgroups, the patients in quintile
0.86). After stratification into quintiles, !1st week surgery was
8 – 10
Conclusion
1,2
logical profile of the disease could explain this trend, with an
surgery are well-defined in the international guidelines,11 – 13 no
increase are
in complicated
situations as
owing
to a greater(%).
incidence
Values
expressed
number
consensus exists on the optimal timing of surgical treatment
5 were younger (P , 0.0001), were more likely to have Staphyloassociated
with
a trend
of a decrease
in 6-month mortality in
of more virulent microorganisms and intracardiac material infecduring the active phase of infection because of a lack of evidence-
tions.3 – 5 Moreover,
the development
of surgical techniques and
CLINICAL RESEARCH
INTRO
Endocarditis
The timing of surgery influences mortality and
infective endocarditis: a propensity analysis
Franck Thuny 1, Sylvain Beurtheret 2, Julien Mancini 3, Vlad Gariboldi 2,
Jean-Paul Casalta 4, Alberto Riberi 2, Roch Giorgi 3, Frédérique Gouriet 4,
Laurence Tafanelli1, Jean-François Avierinos 1, Sébastien Renard 1, Frédéric Collart 2,
Didier Raoult 4, and Gilbert Habib 1*
Guidelines
1
EuropHeartJ:2011:32,2027–2033
3
Li_erature
20
To determine whether the timing of surgery could influence mortality and morbidity in adults with complicated infective endocarditis (IE).
.....................................................................................................................................................................................
Methods
surgery was associated with a trend of decrease in 6-month mortality in the quintile of patients with the most likelihood of undergoing this early surgical management [quintile 5: 11% vs. 33%, odds ratio (OR) ¼ 0.18, 95% CI (confidence interval) 0.04 –0.83, P ¼ 0.03]. Patients of this subgroup were younger, were more likely to have
P ¼ 0.05).
.....................................................................................................................................................................................
Conclusion
6 months :
- relapses
- valv. Dysfunc
15
Meta
Annalysis
16%
10
Aims
----------------------------------------------------------------------------------------------------------------------------------------------------------Keywords
4%
Endocarditis † Surgery † Mortality † Prognosis
516%
Introduction
The number 0
of patients operated on during the active phase of
1
physicians to offer surgical treatment to an increasing number of
patients. However, not only does2 the effect of surgery not seem
to be uniform in all patients,8 – 10 but uncertainties remain about
the optimal timing of the operation. Although the indications for
surgery are well-defined in the international guidelines,11 – 13 no
consensus exists on the optimal timing of surgical treatment
during the active phase of infection because of a lack of evidence-
infective endocarditis (IE) has increased during the last decade
and ranges from 30% to 60%.1,2 Recent changes in the epidemiological profile of the disease could explain this trend, with an
increase in complicated situations owing to a greater incidence
of more virulent microorganisms and intracardiac material infecOBADIAJean-François
tions.3 – 5 Moreover,
the development
of surgical techniques and
Conclusion
4%
Adjusted OR=3.4, 95%CI, 1.24-9.60; P=0.02
The
n e w e ng l a n d j o u r na l
of
m e dic i n e
original article
INTRO
Early Surgery versus Conventional Treatment
for Infective Endocarditis
Kang DH
– NKang,
Eng
J Med
2012:
Duk-Hyun
M.D.,
Ph.D., Yong-Jin
Kim,366:2466-73
M.D., Ph.D.,
Sung-Han Kim, M.D., Ph.D., Byung Joo Sun, M.D., Dae-Hee Kim M.D., Ph.D.,
Sung-Cheol Yun, Ph.D., Jong-Min Song, M.D., Ph.D.,
Suk Jung Choo, M.D., Ph.D., Cheol-Hyun Chung, M.D., Ph.D.,
Jae-Kwan Song, M.D., Ph.D., Jae-Won Lee, M.D., Ph.D.,
and Dae-Won Sohn, M.D., Ph.D.
Guidelines
A BS T R AC T
PostopDeaths
5%
3%
BACKGROUND
90eligibleVeget.≥10mm
The timing and indications for surgical intervention to prevent systemic embolism in
infective endocarditis remain controversial. We conducted a trial to compare clinical
outcomes of early surgery and conventional treatment in patients with infective
endocarditis.
From the Divisions of Cardiology (D.-H.
B.J.S., D.-H. Kim, J.-M.S., J.-K.S.),
Li_eratureKang,
Cardiac Surgery (S.J.C., C.-H.C., J.-W.L.),
Infectious Disease (S.-H.K.), and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan; and the Cardiovascular
Center, Seoul National University Hospital, Seoul National University College of
Medicine (Y.-J.K., D.-W.S.) — all in Seoul,
South Korea. Address reprint requests to
Dr. D.H. Kang at the Division of Cardiology, Asan Medical Center, College of MedMeta
icine, University of Ulsan 388-1, PoongAnnalysis
nap-dong, Songpa-ku, Seoul, South Korea,
or at [email protected].
N Engl J Med 2012;366:2466-73.
<48h Copyright © 2012 Massachusetts Medical Society.
Conclusion
METHODS
We randomly assigned patients with left-sided infective endocarditis, severe valve
76randomized
disease, and large vegetations to early surgery (37 patients) or conventional treatment
(39). The primary end point was a composite of in-hospital death and embolic
23%
events that occurred within 6 weeks after randomization.
6Weeksdeath
Embolicevents
3%
RESULTS
All the patients assigned to the early-surgery group underwent valve surgery within
37Hospit/3later
48 hours after
randomization, whereas 30 patients (77%) in the conventional-treatment group underwent surgery during the initial hospitalization (27 patients) or
during follow-up (3). The primary end point occurred in 1 patient (3%) in the earlysurgery group as compared with 9 (23%) in the conventional-treatment group (hazard ratio, 0.10; 95% confidence interval [CI], 0.01 to 0.82; P = 0.03). There was no
significant difference in all-cause mortality at 6 months in the early-surgery and
conventional-treatment groups (3% and 5%, respectively; hazard ratio, 0.51; 95% CI,
0.05 to 5.66; P = 0.59). The rate of the composite end point of death from any cause,
CLINICAL RESEARCH
European Heart Journal Advance Access published February 9, 2009
CLINICAL RESEARCH
veINTRO
surgery on short- and longleft-sidedThe
infective
impact endocarditis:
of valve surgery on short- and longmethodological
approaches
term mortality
in left-sided infective endocarditis:
doresults?
differences in methodological approaches
onflicting
Effect of VS on short- and long-term mortality
explain previous conflicting results?
François Delahaye 12, François Alla 1,2,3*, and for the AEPEI Study Group†
rance; 2Inserm, CIC-EC, Nancy 54000, France; 3CHU Nancy, Epidemiologie, CO No. 34, Nancy Cedex 54035,
1
Nancy-Université,
FacultéBernard,
de médecine,
EA4003,
Nancy 54000,Clinique,
France; 2Inserm,
CIC-EC,
Nancy 54000, France; 3CHU Nancy, Epidemiologie, CO No. 34, Nancy Cedex 54035,
çon 25000, France; 5APHP, Hôpital
Bichat Claude
Centre
d’Investigation
Maladies
Infectieuses
4
5
CHU
Besançon,
Maladies
Infectieuses
et
Tropicales,
Besançon
25000,
France;
APHP,
Hôpital Bichat Claude Bernard, Centre d’Investigation Clinique, Maladies Infectieuses
France;
et Pneumologique Louis Pradel, Chirurgie Cardiothoracique
et Transplantation, Lyon-Bron 69500, France; 7HCL,
et Tropicales, Paris 75018, France; 6HCL, Hôpital Cardiovasculaire et8 Pneumologique Louis Pradel, Chirurgie Cardiothoracique et Transplantation, Lyon-Bron 69500, France; 7HCL,
CHU
Nancy,
Cardiologie,
ire de Physiologie Lyon Nord,
UCBL1
Inserm
U886
‘cardioprotection’,
Lyon,
France;
Hôpital Cardiovasculaire
et Pneumologique Louis Pradel, Laboratoire de Physiologie Lyon11Nord, UCBL1 Inserm U886 ‘cardioprotection’, Lyon, France; 8CHU Nancy, Cardiologie,
10
9
10
Table
7CHU
Relationship
between
valve surgery
and
death34000,
rate,
according
to statistical
methods
Tropicales, Montpellier 34000,
France;
Pontchaillou,
Maladies
Infectieuses,
Rennes
35000,
France;
APHP,
CHU Montpellier,
Maladies
Infectieuses
et Tropicales,
Montpellier
France;
CHU Pontchaillou,
Maladies Infectieuses,
Rennes 35000, France; 11APHP,
Nancy
54000,
France;
et Pneumologique
Louis Pradel,
France
and 12HCL, Hôpital Cardiovasculaire
Hôpital Cardiovasculaire
et Pneumologique Louis Pradel, Cardiologie, Lyon-Bron 69500, France
Hôpital Bichat
Claude Bernard, Cardiologie,
ParisCardiologie,
75018, France;Lyon-Bron
and 12HCL, 69500,
EuropheartJ2009
Li_erature
Received 16 June 2008; revised 27 November 2008; accepted 5 January 2008
Vikram et al. 8
Wang et al. 9
Cabell et al. 6
Downloaded from eurheartj.oxfordjournals.org at BIOREPROD on June 1, 2010
Downloaded from eurheartj.oxfordjournals.org at BIOREPROD on June 1, 2010
n 4,Guidelines
Xavier Duval 5, Jean-François Obadia 6,7,
4, Xavier
10, ,Bruno
11,
Aurélie Tattevin
Bannay1,2,3
HoenIung
Duval 5, Jean-François Obadia 6,7etal.
,
t Le Moing 9, Pierre
Bernard
8, Vincent Le
9, Pierre Tattevin 10, Bernard Iung 11,
†
1,2,3
Moing
Christine
Selton-Suty
*, and for the AEPEI Study Group
Alla
Figure 1 Death hazard functions over time. Equity point is the
time at which the area between the surgical group curve and the
non-surgical group curve during the short-term period (area A) is
equal to the area between the surgical group curve and the nonsurgical group during the long-term period (area B).
Equity point estimation
5
Aksoy et al.
Tleyjeh et al. 7
To estimate a global effect of VS, we estimated the point in time at
.... .... ..... ..... ..... .... ..... ..... ..... ..... .... ..... ..... ..... .... ..... ..... ..... .... ..... ..... ..... .... ..... ..... ..... .... ..... ..... ..... ..... .... ..... ..... ..... ....
..... ..... ..... .... ..... ..... ..... .... ..... ..... ..... .... ..... .....
which early high post-operative risk (adjusted HR of death within 14
ary 2008
1. Previous studies: statistical Population definition
Complicated left-sided native valve IEa Prosthetic valve IE Native valve IE daysAll
IE
Left-sided
following
VS) was offset
by laterIElow risk (adjusted HR of death
within
the 14th day after 6VSmonths
and the end of follow-up) and the point
methods
and
results
Follow-up
duration
6 months
Inhospital
Inhospital
5 years
Aims
The aim of this study was to evaluate the effect of valve surgery (VS) in infective endocarditis (IE) on 5-year mortality in time at which VS provides an overall survival advantage (Figure 1).
No.
ofwhether
patients conflicting
546
evaluate the effect of valve surgery (VS) inand
infective
endocarditis
(IE) on 5-year
mortality
to evaluate
results513
reported by previous studies could be367
due to differences 1516
in their meth- This426
point in time was defined as the ‘equity point’ (EP).13,14 In a
Cox model
Logistic regression Logistic regressiongraphic
Coxofmodel
model
death hazard Cox
function
over time, the EP is the time at
nflicting results reported by previous studies
couldModelling
be due to differences in their
methodological
approaches.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Surgery
. . . . . . . . . . .coding
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Binary
. . . . . . . . .variable
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Binary
. . . . . . . . .variable
. . . . . . . . . . . . . . . . . .Binary
. . . . . . . . .variable
. . . . . . . . . which
the area
between the
surgical group
curve and thecovariate
non-surgical
Binary
variable
Partitioned
time-dependent
b is equal to the area
IE were selected from a prospective, population-based group curve during the short-term
period
. . . . . . . . . . . . . . . . . . . . . . . . . . . . .Methods
. . . . . . . . . . . . . . . . . . . . . . . . . Four
. . . . . . hundred
. . . . . . . . . . and
. . . . .forty-nine
. . . . . . . . . . . .patients
. . . . . . . . .with
. . . . . a. . definite
. . . . . . . . . left-sided
..
Short-term
Mid-termc between
Association between VS and 5-year mortality was examined with a Cox model. To determine thed impact of the surgical group curve and the non-surgical group curve during the
and results
Adjusted
death rate HR or
OR 0.40 (0.18–0.91)
0.56 (0.23–1.36)
NS
0.27 (0.13–0.55) 6.21 (2.72–14.18) 0.92
(0.48–1.76)
patients with
a definite
left-sided IE were study.
selected
from a prospective,
population-based
Meta
(CI) of EP time was
different methodological approaches, we also analysed the relationship between VS and mortality in our database, long-term period. The 95% confidence interval 15
(95% CI)To
of valve
surgery the impact of
VS and 5-year
mortality was examined with
a
Cox
model.
determine
Annalysis
estimated by Monte Carlo simulation technique. This method conaccording to each method used in the five previous studies. Valve surgery was performed in 240 patients (53%).
in randomly generating
10 000) of indicators
No.VS
of patients
82
447 hazard sists559
449a high number (i.e. 449
2. Re-analysis
from ourIt was
proaches, we also analysed
the relationship
between
and an
mortality
our372
database,
associated
with
increase in
in short-term
mortality [within the first 14 post-operative
days; adjusted
(HR and death hazard function), from a normal distribution with
Adjusted
death
rate
HR
or
OR
0.56
(0.31–0.99)
0.92
(0.11–7.42)
0.65
(0.33–1.29)
0.58
(0.41–0.82)
6.51
(3.74–11.31)
0.65
database
using
the
same
used in the five previous studies. Valve surgery
was3.69;
performed
in 240 patients
(53%).
ratio (HR),
95% confidence
interval (CI),
2.17– 6.25; P , 0.0001] and a decrease in long-term mortality observed mean and standard deviation, then calculating(0.35–1.21)
corresponding
(95%
CI)
of
valve
surgery
statistical
methods
0.55; 95% CI, days;
0.35–0.87;
P ¼ 0.01).
At least 188 days of follow-up were required for VS to provide EPs and describing their distribution [median (interquartile range)].
crease in short-term mortality [within the(adjusted
first 14HR,
post-operative
adjusted
hazard
an overall
advantage.
applying
each study’s method to our database, we obtained results similar to
fidence interval (CI), 2.17– 6.25; P , 0.0001]
andsurvival
a decrease
in When
long-term
mortality
a
those
reported.
Complicated
IE
was
defined
as
an
IE
with
at
least
one
of
these
signs:
presence
of
0.35–0.87; P ¼ 0.01).. .bAt
. . . . .least
. . . . . . . .188
. . . . . . .days
. . . . . . . .of
. . . . follow-up
. . . . . . . . . . . . . . . .were
. . . . . . . . .required
. . . . . . . . . . . . . . for
. . . . . .VS
. . . . . to
. . . . .provide
. . . .vegetations,
. . . . . . . . . . . . . .intracardiac
. . . . . . . . . . . . .abscess,
. . . . . . . . . .heart
. . . . . .failure,
. . . . . . . . stroke,
. . . . . . . . .or. . .emboli.
. . . . . . . . . . . . . . . . . . . . . . . . . Subgroup analyses
Short-term:
0–7
days
after
surgery.
Previous
conflictingwe
results
appear results
to be related
to differences
in statistical methods. When using appropriate models, We performed a priori planned subgroup analyses using adjusted Cox
e. When applying eachConclusion
method
to
our
database,
obtained
similar
to
c study’s
14daysèIncreasedMortalityHR=3.69(2.17–6.25;P,0.0001]
Mid-term: 8 days to 6 months after surgery.
regression analysis. The association between VS and 5-year survival
we found that VS was significantly associated with reduced long-term mortality.
d
Atleast188daysofFUrequiredtoprovide
was examined per following subgroups: gender (men and women),
Non-significant, OR not available.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . .- .- .- .- .- .- .- .- .- .- .- .- .- .- .- .- .- .- .-.- .- .- .- .- .- .- .- .- .- .- .- .-.- .- .- .- .- .- .- .- .- .- .- .- .-.- .- .- .- .- .- .- .- .- .- .- .- .-.- .- .- .- .- .- .- .- .- .- .- .- .-.- .- .- .- .- .- .- .- .- .- .- .- .-.- .- - - - - - - - - - - -- - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - age (, and !60 years), history of valvular disease (history of native
In (i), statistical methods ofInfective
the five previous
studies †areValve
summarized
and†in (ii),
the same†methods
are applied
to our database.
Keywords
endocarditis
surgery
Mortality
Propensity
analysis
asurvivaladvantage.
ppear toConclusion
be related to differences
in statisticalè
methods.
When using appropriate models,
valve disease and prosthetic valve), IE location (mitral IE, aortic IE,
long-term
decreasemortalityHR=0.55(0.35–0.87;P1⁄40.01)
cantly associated with reduced long-term mortality.
-------------------------------------------------------------------------------------------------
ve OBADIAJean-François
surgery † Mortality † Propensity
analysis
HVS-NewYork–17-18/03/2016 mitral and aortic IE), causative microorganisms (streptococci, Staphylococcus aureus, coagulase-negative staphylococci, others). Subgroups
values were compared using x2 tests of interaction.
INTRO
338
OpUmalUmingforearly
surgeryinIE:ameta-analysis.
Guidelines
Li_erature
Meta
Annalysis
F. Liang et al. / Interactive CardioVascular and Thoracic Surgery
5011publicaUons
FuxiangLiangetal.
Interac0veCardioVascularand
ThoracicSurgery22(2016)336–34
earlyversusnon-earlySurgery
EarlysurgeryèduringiniUalhospitalizaUon
beforetheendofanUbioUcs
Follow-up>6months
N=16
Conclusion
Figure 1: Literature search and study selection.
HVS-NewYork–17-18/03/2016 8141PaUents
al. [16]
– et al. [17]
Thuny
y et al. [17] Wang
√ et al. [20]
g et al. [20] Wang
√ et al. [21]
g et al. [21] Jia –et al. [22]
Vikram
al. [22]
– et al. [19]
Tleyjeh et al. [18]
m et al. [19] √
eh etINTRO
al. [18] –
√
√
–
–
√
–
√
√
Wang
√ et al. [20] √
Wang et al. [21] √
√
Jia et al. [22]
√
√
Vikram et al. [19]√
√ et al. [18]
Tleyjeh
√
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√
In-hospitalmortality
Guidelines
Li_erature
Meta
Annalysis
Conclusion
IE, comparing
mortality in patients with
early
surgery, including subgroup analysis for different operation time
Figure 2: In-hospital
surgery
versus non-early
g et al. [20]
g et al. [21]
al. [22]
m et al. [19]
eh et al. [18]
√
–
–
√
–
INTRO
√
√
√
√
√
√
√
√
√
√
–
–
–
√
–
√
√
√
√
√
√
√
√
√
√
√
√
–
√
–
–
–
–
–
–
√
–
–
√
√
341
341
Longtermmortality
Guidelines
STATE-OF-THE-ART
Li_erature
Meta
Annalysis
Conclusion
Figure 3: Long-term mortality in patients with IE, comparing early surgery versus non-early surgery, including subgroup analysis for different operation time periods.
Figure 3: Long-term mortality in patients with IE, comparing early surgery versus non-early surgery, including subgroup analysis for different operation time periods.
INTRO
342
Figure 4: In-hospital mortality in patients with NVE and PVE. NVE: native valve endocarditis; PVE: prosthetic valve en
InHospitalmortality
Longtermmortality
Guidelines
Li_erature
Meta
Annalysis
Figure
5: Long-term
invalve
patients
with NVE and PVE. NVE: native valve endocarditis; PVE: prosthetic valve en
Figure 4: In-hospital mortality in patients with NVE and PVE. NVE: native valve
endocarditis;
PVE:mortality
prosthetic
endocarditis.
Conclusion
INTRO
Guidelines
RegularmeeUngsatapreciseUme(Weeklybasis)
Pre-programannouncingthefilestodiscus
aminimumof3differentspecialUes
Severalmembers/SpecialUes
InvolvingCoordinator/nurse
Wri_endecisionsrecorded
YearlyevaluaUon
Li_erature
Meta
Annalysis
Conclusion

Timing of Surgery in InfecOve EndocardiOs

Transcription

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