Treatment of Endocarditis

A Decade of Experience

Matthew Slater, Christopher B. Komanapalli, Uttam Tripathy, Pasala Ravichandran, Ross M. Ungerleider

    Research output: Contribution to journalArticle

    13 Citations (Scopus)

    Abstract

    Background: Endocarditis represents a small proportion of cardiovascular disease but is associated with high mortality. Previous studies have reported a range of outcomes, and determinants of mortality remain poorly defined. Methods: The goal of this retrospective study was to identify independent variables for early and late mortality in 364 consecutive patients with endocarditis over a 10-year period. Results: The mean age of patients was 48.2 years, 35% had a history intravenous drug use, 19.8% were reoperative, and 93% had native valve endocarditis. Fever (68%) and fatigue (36%) were the most common presenting symptoms, and congestive heart failure (52%), embolization (45%), and uncontrolled sepsis (36%) were the most common indications for surgery. Overall survival at discharge, 1, 5, and 10 years was 87%, 76%, 55%, and 31%, respectively. Survival at discharge, 5, and 10 years was 91%, 69%, and 41% for surgical patients and 85%, 60%, and 31% for medically treated patients, respectively. Surgery was associated with improved short-term and long-term survival (p <0.0.01). Independent predictors of early death were hemodynamic instability (p = 0.013) and age older than 55 years (p <0.025). Medical treatment (p = 0.005), age older than 55 years (p = 0.032), institution (p <0.001), New York Heart Association functional class III or IV (p = 0.002), and hemodynamic instability (p = 0.044) were predictive of late death. Conclusions: Short-term and long-term mortality from endocarditis remains high, although surgically treated patients had improved survival. Differing outcomes from two geographically similar institutions highlight the limitations of extrapolating risk factors between disparate patient populations.

    Original languageEnglish (US)
    Pages (from-to)2074-2080
    Number of pages7
    JournalAnnals of Thoracic Surgery
    Volume83
    Issue number6
    DOIs
    StatePublished - Jun 2007

    Fingerprint

    Endocarditis
    Survival
    Mortality
    Therapeutics
    Hemodynamics
    Fatigue
    Sepsis
    Fever
    Cardiovascular Diseases
    Heart Failure
    Retrospective Studies
    History
    Pharmaceutical Preparations
    Population

    ASJC Scopus subject areas

    • Cardiology and Cardiovascular Medicine
    • Surgery

    Cite this

    Slater, M., Komanapalli, C. B., Tripathy, U., Ravichandran, P., & Ungerleider, R. M. (2007). Treatment of Endocarditis: A Decade of Experience. Annals of Thoracic Surgery, 83(6), 2074-2080. https://doi.org/10.1016/j.athoracsur.2007.01.051

    Treatment of Endocarditis : A Decade of Experience. / Slater, Matthew; Komanapalli, Christopher B.; Tripathy, Uttam; Ravichandran, Pasala; Ungerleider, Ross M.

    In: Annals of Thoracic Surgery, Vol. 83, No. 6, 06.2007, p. 2074-2080.

    Research output: Contribution to journalArticle

    Slater, M, Komanapalli, CB, Tripathy, U, Ravichandran, P & Ungerleider, RM 2007, 'Treatment of Endocarditis: A Decade of Experience', Annals of Thoracic Surgery, vol. 83, no. 6, pp. 2074-2080. https://doi.org/10.1016/j.athoracsur.2007.01.051
    Slater M, Komanapalli CB, Tripathy U, Ravichandran P, Ungerleider RM. Treatment of Endocarditis: A Decade of Experience. Annals of Thoracic Surgery. 2007 Jun;83(6):2074-2080. https://doi.org/10.1016/j.athoracsur.2007.01.051
    Slater, Matthew ; Komanapalli, Christopher B. ; Tripathy, Uttam ; Ravichandran, Pasala ; Ungerleider, Ross M. / Treatment of Endocarditis : A Decade of Experience. In: Annals of Thoracic Surgery. 2007 ; Vol. 83, No. 6. pp. 2074-2080.
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    abstract = "Background: Endocarditis represents a small proportion of cardiovascular disease but is associated with high mortality. Previous studies have reported a range of outcomes, and determinants of mortality remain poorly defined. Methods: The goal of this retrospective study was to identify independent variables for early and late mortality in 364 consecutive patients with endocarditis over a 10-year period. Results: The mean age of patients was 48.2 years, 35{\%} had a history intravenous drug use, 19.8{\%} were reoperative, and 93{\%} had native valve endocarditis. Fever (68{\%}) and fatigue (36{\%}) were the most common presenting symptoms, and congestive heart failure (52{\%}), embolization (45{\%}), and uncontrolled sepsis (36{\%}) were the most common indications for surgery. Overall survival at discharge, 1, 5, and 10 years was 87{\%}, 76{\%}, 55{\%}, and 31{\%}, respectively. Survival at discharge, 5, and 10 years was 91{\%}, 69{\%}, and 41{\%} for surgical patients and 85{\%}, 60{\%}, and 31{\%} for medically treated patients, respectively. Surgery was associated with improved short-term and long-term survival (p <0.0.01). Independent predictors of early death were hemodynamic instability (p = 0.013) and age older than 55 years (p <0.025). Medical treatment (p = 0.005), age older than 55 years (p = 0.032), institution (p <0.001), New York Heart Association functional class III or IV (p = 0.002), and hemodynamic instability (p = 0.044) were predictive of late death. Conclusions: Short-term and long-term mortality from endocarditis remains high, although surgically treated patients had improved survival. Differing outcomes from two geographically similar institutions highlight the limitations of extrapolating risk factors between disparate patient populations.",
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