Impact of cardiac surgery on short- and long-term mortality among patients with left-sided Staphylococcus aureus infective endocarditis
Abstrakt
Purpose: Staphylococcus aureus (SA), which is the leading cause of infective endocarditis (IE), has increased in prevalence over recent years. Contemporary data on the long-term benefits of cardiac surgery among patients with SA and non-SA IE are sparse.
Methods: The aim of the present study was to compare short-term and long-term mortality risk among surgical and non-surgical patients with SA and non-SA IE. We carried out a retrospective survey of consecutive left-sided IE adult patients, admitted over a 15-year period to the University Hospital Hradec Kralove, Charles University, Czech Republic (between 1998 and 2006), and to the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (between 2009 and 2016).
Results: In a group of 196 patients (155 males; median age 64 years), a total of 206 left-sided IE episodes were identified. Septic shock (OR 10.1), indication for haemodialysis (OR 7.8), and stroke (OR 8.0) were associated with a higher in-hospital mortality, while cardiac surgery at the time of S. aureus IE episode was associated with a lower in-hospital mortality (OR 0.022).
Surgically treated patients with SA had a 4.25-fold lower risk of 6-month mortality than surgically treated patients without SA infection. Conservative treatment at the time of the IE episode was a detrimental factor that significantly affected long-term outcomes (OR 2.028).
Conclusions: A favourable impact of cardiac surgery was shown across all segments of the study: in-hospital mortality, 6-month mortality, and long-term survival. Individual risk stratification towards conservative or surgical treatment is fundamental for all IE episodes, particularly in patients with SA infection.