The timing of surgery influences mortality and morbidity in adults with severe complicated infective endocarditis: a propensity analysis

Aims To determine whether the timing of surgery could influence mortality and morbidity in adults with complicated infective endocarditis (IE). Methods and results In 291 consecutive adults with definite IE who underwent surgery during the active phase, we compared those operated on within the first week of antimicrobial therapy (n = 95) to those operated on later (n 191). The impact of the timing of surgery on 6-month mortality, relapses, and postoperative valvular dysfunctions (PVD) was analysed using propensity score (PS) analyses. After stratification of the cohort into quintiles based on the PS, <= 1st week surgery was associated with a trend of decrease in 6-month mortality in the quintile of patients with the most likelihood of undergoing this early surgical management [quintile 5: 11% vs. 33%, odds ratio (OR) = 0.18, 95% CI (confidence interval) 0.04-0.83, P = 0.03]. Patients of this subgroup were younger, were more likely to have Staphylococcus aureus infections, congestive heart failure, and larger vegetations. Besides, <= 1st week surgery was associated with an increased number of relapses or PVD (16% vs. 4%, adjusted OR = 2.9, 95% CI 0.99-8.40, P = 0.05). Conclusion Surgery performed very early may improve survival in patients with the most severe complicated IE. However, a greater risk of relapses and PVD should be expected when surgery is performed very early.