Outcome in Patients With Left‐Sided Native‐Valve Infective Endocarditis and Isolated Large Vegetations
Open accessAbstract
Background: In patients with left‐sided native‐valve infective endocarditis (IE), the risk of embolism is increased with a vegetation size ≥10 mm. For this reason—according to guidelines—surgery may be considered in patients with isolated large vegetations (without any other indication for surgery). However, the value of surgery in this patient subset has never been systematically studied. Hypothesis: We hypothesized that surgery may be superior to medical therapy in terms of clinical outcome in the aforementioned patients. Methods: All patients who presented at our institution between January 2000 and July 2012 with isolated left‐sided native‐valve IE and large vegetations (≥10 mm) were examined. Patients with conventional indications for surgical treatment were excluded. Follow‐up for clinical events was performed according to predefined definitions. Results: A total of 71 patients with left‐sided native‐valve IE and isolated large vegetations qualified for inclusion into the study cohort. Mean vegetation length was 17 ± 5 mm. A total of 59 patients underwent surgery after a mean of 5 ± 6 days following the initiation of antibiotic treatment. Mean follow‐up duration was 6.0 ± 2.9 years. Surgical compared to purely medical treatment was associated with a significant increase in long‐term all‐cause mortality (P = 0.03 by log‐rank test, unadjusted analysis). Upon multivariable Cox regression analysis, surgical treatment, affection of mitral valve, blood cultures positive for Staphylococcus aureus, and increasing age showed trends as independent predictors of long‐term mortality. Conclusions: Surgical treatment in patients with left‐sided native‐valve IE and isolated large vegetations without any other indication for surgery seems to be associated with excess mortality. A randomized controlled trial of surgery vs conservative treatment in this subset of patients is justified.
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Data from nonrandomized trials from a single-center experience and an international collaboration support the notion that early valve surgery may not be beneficial in all patients with native or prosthetic valve infective endocarditis caused by S aureus.
“Data from nonrandomized trials from a single-center experience 250 and an international collaboration 251 support the notion 252 that early valve surgery may not be beneficial in all patients with native or PVE caused by S aureus.”
From Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association (2015) · cites this paper as [250]
The Abstract and Discussion report that surgery appeared to be associated with higher mortality in patients with left-sided native-valve endocarditis and isolated large vegetations, supporting the qualified notion that surgery may not benefit every patient. The study did not examine prosthetic-valve endocarditis or establish the surgery outcome specifically for patients with S. aureus infection; it included S. aureus blood-culture status as a predictor of mortality. Page numbers are not available for the decisive Abstract and Discussion passages in our copy. (LLM, conf=0.88)
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References 21 · Cited by 28
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- [20]20. S. Desch et al: Native-valve IE and large vegetations Published online in Wiley Online Library (wileyonlinelibrary.com) DOI:10.1002/clc.22315 © 2014 Wiley Periodicals, Inc.
- Authors
- Desch, S., Freund, A., de Waha, S., Eitel, I., Lurz, P., Stiermaier, T., Fuernau, G., Schuler, G., & Thiele, H.
- Affiliations
- University of Lübeck (DE)
- Leipzig Heart Institute (DE)
- Department of Internal Medicine/Cardiology, Heart Center University of Leipzig Leipzig Germany
- Department of Internal Medicine/Cardiology, Angiology, Intensive Care Medicine University of Luebeck Luebeck Germany
- Corresponding author
- Desch, Steffen
- ORCID
- Venue
- Clinical Cardiology
- Publisher
- Wiley
- Published
- 2014-08-25
- Volume
- 37
- Issue
- 10
- Pages
- 626-633
- ISSN
- 0160-9289 (ISSN-L)
- 1932-8737
- PMC
- PMC6649444
- OpenAlex
- W1596097198
- Semantic Scholar
- d991709f8265c9fd30d701ae2133c021272c44b6
- Cited by
- 28
- References
- 21
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 4 · 2023: 5 · 2022: 3 · 2021: 2 · 2020: 2 · 2019: 2 · 2018: 1 · 2017: 1 · 2016: 1 · 2015: 3 · 2014: 1
- FWCI
- 1.52
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Clinical Cardiology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Infective Endocarditis Diagnosis and Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Valve Diseases and Treatments
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Streptococcal Infections and Treatments
- Keywords
- infective endocarditis, native valve endocarditis, left-sided endocarditis, mitral valve, surgical treatment, conservative medical management, all-cause mortality, Staphylococcus aureus, mortality risk factors
- MeSH terms
- Aged, Endocarditis, Female, Follow-Up Studies, Cardiac Surgical Procedures, Humans, Male, Middle Aged, Risk Factors, Staphylococcal Infections, Survival Analysis, Prosthesis-Related Infections, Treatment Outcome, Risk Assessment
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