568. In-Hospital and One Year Mortality in Patients Undergoing Early Surgery for Prosthetic Valve Endocarditis
Session: Oral Abstract Session: Clinical Epidemiology in Action
Thursday, October 3, 2013: 3:00 PM
Room: The Moscone Center: 300
Background: There are limited prospective, controlled data evaluating survival in patients receiving early surgery versus medical therapy for prosthetic valve endocarditis (PVE). We sought to determine the in-hospital and 1-year mortality in patients with PVE who undergo valve replacement during index hospitalization compared with patients who receive medical therapy alone, after controlling for survival and treatment selection bias.

Methods: Using a prospective, multinational observational cohort of patients with definite PVE, the effect of valve replacement on in-hospital and 1-year mortality was assessed after adjusting for survival and treatment selection bias. The cohort was stratified by propensity for surgery, and outcomes were compared between the treatment groups within each stratum.

Results: Of the 1025 patients with PVE, 490 (48%) underwent early surgery and 535 (52%) were treated with medical therapy. Compared with medical therapy, early surgery was associated with lower in-hospital mortality in the unadjusted analysis and after controlling for treatment selection bias (in-hospital mortality HR 0.44 [95% CI: 0.38-0.52] and lower 1-year mortality (HR 0.57 [95% CI: 0.49-0.67]). The lower mortality associated with surgery did not persist after adjustment for survivor bias (in-hospital mortality HR 0.90 [95% CI: 0.76-1.07] and 1-year mortality HR 1.04 [95% CI: 0.89-1.23]). Subgroup analysis indicated a lower in-hospital mortality with early surgery in the highest surgical propensity quintile (21% vs. 38%, respectively; p=0.031). At 1-year follow-up, the reduced mortality with surgery was observed in the 4th (25% vs. 43%; p=0.007) and 5th (28% vs. 50%; p=0.007) quintiles of surgical propensity.

Conclusion: Prosthetic valve endocarditis remains associated with a high 1-year mortality rate. After adjustment for differences in clinical characteristics and survival bias, early valve replacement was not associated with lower mortality compared to medical therapy in the overall cohort.

Tahaniyat Lalani, MBBS, MHS1, Vivian Chu, MD2, Lawrence Park, PhD3, E Cecchi, MD4, G. Ralph Corey2, Emanuele Durante-Mangoni5, Vance Fowler, Jr, MD MHS6, David Gordon7, Paolo Grossi8, Margaret Hannan, MBBCh, MSc, PhD9, Bruno Hoen, MD10, Patricia Munoz11, Hussien Rizk, MD12, Souha Kanj, MD, FIDSA13, Christine Selton-Suty14, Daniel J. Sexton, MD, FIDSA2, Denis Spelman, MBBS FRACP FRCPA MPH15, Veronica Ravasio, MD16, Marie-Françoise Tripodi, MD17 and Andrew Wang, MD2, (1)Infectious Disease Clinical Research Program, Portsmouth, VA, (2)Duke University Medical Center, Durham, NC, (3)Durham VA Medical Center, Durham, NC, (4)ICE-PCS Investigators, Durham, NC, (5)AO Monaldi, Naples, Italy, (6)Duke University, Durham, NC, (7)Flinders Medical Centre, South Australia, Australia, (8)Ospedale Di Circolo Varese, Varese, Italy, (9)Mater University Hospital Dublin, Dublin, Ireland, (10)University Hospital, BESANCON, France, (11)Hospital General Universitario Gregorio Marañón, Madrid, Spain, (12)Cairo University Medical School, Cairo, Egypt, (13)American University of Beirut Medical Center, Beirut, Lebanon, (14)CHU Nancy-Brabois, Vandœuvre-lès-Nancy, France, (15)Dept. of Microbiol. & Infectious Diseases Unit, Alfred Hosp., Melbourne, Australia, (16)Ospedali Riuniti, Naples, Italy, (17)Intl. International Collaboration on Endocarditis, Durham, NC

Disclosures:

T. Lalani, None

V. Chu, None

L. Park, None

E. Cecchi, None

G. R. Corey, None

E. Durante-Mangoni, None

V. Fowler, Jr, None

D. Gordon, None

P. Grossi, None

M. Hannan, None

B. Hoen, None

P. Munoz, None

H. Rizk, None

S. Kanj, None

C. Selton-Suty, None

D. J. Sexton, None

D. Spelman, None

V. Ravasio, None

M. F. Tripodi, None

A. Wang, American Heart Association Mid-Atlantic Affiliate Grant in Aid: Grant Investigator, Grant recipient

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