Author + information
- Shailee Shah,
- Syed Hussain,
- Gosta Pettersson,
- Amy S. Nowacki,
- Steve Gordon and
- Nabin Shrestha
Background: Patients with prosthetic valve endocarditis (PVE) who are not treated surgically have poor clinical outcomes. This study was undertaken to compare outcomes of non-surgical with surgical treatment for PVE.
Methods: Patients admitted to Cleveland Clinic with PVE from April 1, 2008 to December 31, 2012 were identified from our institution's infective endocarditis (IE) registry. Treatment groups (non-surgical or surgical) were defined by decision to treat surgically, and the date of this decision was defined as time zero. Propensity to be treated surgically was calculated in a logistic regression model that included pre-selected variables felt to affect a decision on surgery, and baseline variables with significant univariable associations with treatment group assignment. Hazard for death was compared between non-surgically and surgically-treated patients using a reduced Cox proportional hazards model that included propensity to be treated surgically, and baseline variables with significant univariable associations with survival. In-hospital mortality, one-year mortality, subsequent surgery for IE, and readmission or death within 90 days, were examined using logistic regression models adjusted for propensity to be treated surgically.
Results: Of 330 identified patients with PVE, 77 were treated non-surgically and 253 surgically. Mean age was 61 yrs, 71% were male, and 28% had Staphylococcus aureus infection. All but 9 had left sided involvement, and 59% had invasive disease. Non-surgically-treated patients had a higher hazard of death (HR 6.68, 95% CI 3.80 – 11.74, p-value <0.0001) compared to surgically-treated patients. Non-surgical treatment was associated with higher odds of in-hospital death (OR 4.65, 95% CI 1.88 – 11.47, p-value 0.0008), death within one year (OR 11.70, 95% CI 5.25 – 27.27, p-value <0.0001), subsequent surgery for IE (OR 8.02, 95% CI 2.25 – 28.34, p-value 0.0012), and readmission or death within 90 days (OR 6.57, 95% CI 2.76 – 16.31, p-value <0.0001), compared to surgical treatment.
Conclusions: Non-surgical treatment of PVE is significantly less effective than surgical treatment.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Valvular Heart Disease: Endocarditis
Abstract Category: 36. Valvular Heart Disease: Clinical
Presentation Number: 1103-028
- 2017 American College of Cardiology Foundation