BACKGROUND:
Use of surgery for the treatment of IE as related to surgical indications and operative risk for mortality has not been well defined.
METHODS AND RESULTS:
The International Collaboration on Endocarditis-PLUS (ICE-PLUS) is a prospective cohort of consecutively enrolled patients with definite IE from 29 centers in 16 countries. We included patients from ICE-PLUS with definite left-sided, non-cardiac device related IE who were enrolled between September 1, 2008 and December 31, 2012. 1,296 patients with left-sided IE were included. Surgical treatment was performed in 57% of the overall cohort and in 76% of patients with a surgical indication. Reasons for non-surgical treatment included poor prognosis (33.7%), hemodynamic instability (19.8%), death before surgery (23.3%), stroke (22.7%), and sepsis (21%). Among patients with a surgical indication, surgical treatment was independently associated with the presence of severe aortic regurgitation, abscess, embolization prior to surgical treatment, and transfer from an outside hospital. Variables associated with non-surgical treatment were a history of moderate/severe liver disease, stroke prior to surgical decision, and S. aureus etiology. The integration of surgical indication, STS-IE score, and use of surgery was associated with 6-month survival in IE.
CONCLUSIONS:
Surgical decision-making in IE is largely consistent with established guidelines, although nearly one-quarter of patients with surgical indications do not undergo surgery. Operative risk assessment by STS-IE score provides prognostic information for survival beyond the operative period. S. aureus IE was significantly associated with non-surgical management.
