The fate of active left-side infective endocarditis with operative indication in absence of valve surgery.
Aged
Aged, 80 and over
Databases as Topic
Decision Making, Shared
Endocarditis
/ complications
Female
Health Resources
Heart Failure
/ etiology
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Palliative Care
Patient Outcome Assessment
Prognosis
Referral and Consultation
Retrospective Studies
Stroke
/ etiology
Time Factors
Treatment Refusal
cardiac surgery indication
clinical care
endocarditis
natural history
no cardiac surgery
survival
Journal
Journal of cardiac surgery
ISSN: 1540-8191
Titre abrégé: J Card Surg
Pays: United States
ID NLM: 8908809
Informations de publication
Date de publication:
Nov 2020
Nov 2020
Historique:
pubmed:
23
8
2020
medline:
7
4
2021
entrez:
23
8
2020
Statut:
ppublish
Résumé
Although the benefits of surgery in infective endocarditis (IE) are clear, an unneglectable proportion of patients do not undergo surgery despite clear operative indication. Outcomes of these patients are poorly reported. With this study, we aim to analyze patient profiles, indication for surgery, decision-making, and outcomes of patients not undergoing surgery despite contemporary surgical indications. Retrospective review of single institution database of patients with IE was done to identify patients that, although a clear surgical indication did not receive surgery. We aimed to review the most contemporary practice from June 2014 to December 2018. Only patients who were physically evaluated at our facility were included. Follow up was 100% complete. Kaplan-Meier methods were used to estimate survival and freedom from a composite outcome of death, stroke, and heart failure. Of the 174 patients with surgical indication during the review period, 46 (27%) did not undergo surgery. The reasons for not pursuing surgery were varied and usually multiple, with severe brain injury and end stage liver disease between the most common. The 30-day mortality was 63%, and the estimated survival at 6 months, 1 year, and 2 years was respectively 22%, 15%, and 10%. The mortality of this cohort of patients is extremely high. A multidisciplinary evaluation is of paramount importance in the decision-making process with shared responsibility for denial of operative options. In a perspective of correct healthcare resources allocation an early palliative care consult may need to be considered in some of those patients.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
3034-3040Subventions
Organisme : Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)
ID : 80:20 research grant
Informations de copyright
© 2020 Wiley Periodicals LLC.
Références
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