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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Analysis of the Impact of Early Surgery on In-hospital Mortality of Native Valve Endocarditis: Use of Propensity Score and Instrumental Variable Methods to Adjust for Treatment Selection Bias</title><author><name sortKey="Lalani, Tahaniyat" sort="Lalani, Tahaniyat" uniqKey="Lalani T" first="Tahaniyat" last="Lalani">Tahaniyat Lalani</name><affiliation><nlm:aff id="A1">Duke Clinical Research Institute, Duke University Medical Center, Durham, NC</nlm:aff></affiliation><affiliation><nlm:aff id="A2">Division of Infectious Diseases, Duke University Medical Center, Durham, NC</nlm:aff></affiliation></author><author><name sortKey="Cabell, Christopher H" sort="Cabell, Christopher H" uniqKey="Cabell C" first="Christopher H" last="Cabell">Christopher H. Cabell</name><affiliation><nlm:aff id="A3">Quintiles Translational Corporation, Durham, NC</nlm:aff></affiliation></author><author><name sortKey="Benjamin, Daniel K" sort="Benjamin, Daniel K" uniqKey="Benjamin D" first="Daniel K" last="Benjamin">Daniel K. Benjamin</name><affiliation><nlm:aff id="A4">Clemson University, Clemson, SC</nlm:aff></affiliation></author><author><name sortKey="Lasca, Ovidiu" sort="Lasca, Ovidiu" uniqKey="Lasca O" first="Ovidiu" last="Lasca">Ovidiu Lasca</name><affiliation><nlm:aff id="A4">Clemson University, Clemson, SC</nlm:aff></affiliation></author><author><name sortKey="Naber, Christoph" sort="Naber, Christoph" uniqKey="Naber C" first="Christoph" last="Naber">Christoph Naber</name><affiliation><nlm:aff id="A5">Department of Cardiology, West German Heart Center Essen, University of Duisburg-Essen, Essen, Germany</nlm:aff></affiliation></author><author><name sortKey="Fowler, Vance G" sort="Fowler, Vance G" uniqKey="Fowler V" first="Vance G." last="Fowler">Vance G. Fowler</name><affiliation><nlm:aff id="A1">Duke Clinical Research Institute, Duke University Medical Center, Durham, NC</nlm:aff></affiliation><affiliation><nlm:aff id="A2">Division of Infectious Diseases, Duke University Medical Center, Durham, NC</nlm:aff></affiliation></author><author><name sortKey="Corey, G Ralph" sort="Corey, G Ralph" uniqKey="Corey G" first="G Ralph" last="Corey">G Ralph Corey</name><affiliation><nlm:aff id="A1">Duke Clinical Research Institute, Duke University Medical Center, Durham, NC</nlm:aff></affiliation><affiliation><nlm:aff id="A2">Division of Infectious Diseases, Duke University Medical Center, Durham, NC</nlm:aff></affiliation></author><author><name sortKey="Chu, Vivian H" sort="Chu, Vivian H" uniqKey="Chu V" first="Vivian H" last="Chu">Vivian H. Chu</name><affiliation><nlm:aff id="A1">Duke Clinical Research Institute, Duke University Medical Center, Durham, NC</nlm:aff></affiliation><affiliation><nlm:aff id="A2">Division of Infectious Diseases, Duke University Medical Center, Durham, NC</nlm:aff></affiliation></author><author><name sortKey="Fenely, Michael" sort="Fenely, Michael" uniqKey="Fenely M" first="Michael" last="Fenely">Michael Fenely</name><affiliation><nlm:aff id="A6">St. Vincent's Hospital, Sydney, Australia</nlm:aff></affiliation></author><author><name sortKey="Pachirat, Orathai" sort="Pachirat, Orathai" uniqKey="Pachirat O" first="Orathai" last="Pachirat">Orathai Pachirat</name><affiliation><nlm:aff id="A7">Khon Kaen University, Khon Kaen, Thailand</nlm:aff></affiliation></author><author><name sortKey="Tan, Ru San" sort="Tan, Ru San" uniqKey="Tan R" first="Ru-San" last="Tan">Ru-San Tan</name><affiliation><nlm:aff id="A8">National Heart Center, Singapore</nlm:aff></affiliation></author><author><name sortKey="Watkin, Richard" sort="Watkin, Richard" uniqKey="Watkin R" first="Richard" last="Watkin">Richard Watkin</name><affiliation><nlm:aff id="A9">University of Birmingham, Birmingham, UK</nlm:aff></affiliation></author><author><name sortKey="Ionac, Adina" sort="Ionac, Adina" uniqKey="Ionac A" first="Adina" last="Ionac">Adina Ionac</name><affiliation><nlm:aff id="A10">Victor Babes University of Medicine and Pharmacy, Timisoara, Romania</nlm:aff></affiliation></author><author><name sortKey="Moreno, Asuncion" sort="Moreno, Asuncion" uniqKey="Moreno A" first="Asuncion" last="Moreno">Asuncion Moreno</name><affiliation><nlm:aff id="A11">Hospital Clínic - IDIBAPS, University of Barcelona, Barcelona, Spain</nlm:aff></affiliation></author><author><name sortKey="Mestres, Carlos A" sort="Mestres, Carlos A" uniqKey="Mestres C" first="Carlos A" last="Mestres">Carlos A. Mestres</name><affiliation><nlm:aff id="A11">Hospital Clínic - IDIBAPS, University of Barcelona, Barcelona, Spain</nlm:aff></affiliation></author><author><name sortKey="Casabe, Jose" sort="Casabe, Jose" uniqKey="Casabe J" first="José" last="Casabé">José Casabé</name><affiliation><nlm:aff id="A12">Favaloro University, Instituto de Cardiología y Cirugía Cardiovascular, Buenos Aires, Argentina</nlm:aff></affiliation></author><author><name sortKey="Chipigina, Natalia" sort="Chipigina, Natalia" uniqKey="Chipigina N" first="Natalia" last="Chipigina">Natalia Chipigina</name><affiliation><nlm:aff id="A13">Russian Medical State University, Moscow, Russia</nlm:aff></affiliation></author><author><name sortKey="Eisen, Damon P" sort="Eisen, Damon P" uniqKey="Eisen D" first="Damon P" last="Eisen">Damon P. Eisen</name><affiliation><nlm:aff id="A14">Royal Melbourne Hospital, Victoria, Australia</nlm:aff></affiliation></author><author><name sortKey="Spelman, Denis" sort="Spelman, Denis" uniqKey="Spelman D" first="Denis" last="Spelman">Denis Spelman</name><affiliation><nlm:aff id="A15">Alfred Hospital, Melbourne, Australia</nlm:aff></affiliation></author><author><name sortKey="Delahaye, Francois" sort="Delahaye, Francois" uniqKey="Delahaye F" first="Francois" last="Delahaye">Francois Delahaye</name><affiliation><nlm:aff id="A16">Hosp Louis Pradel, Bron Cedex, France</nlm:aff></affiliation></author><author><name sortKey="Peterson, Gail" sort="Peterson, Gail" uniqKey="Peterson G" first="Gail" last="Peterson">Gail Peterson</name><affiliation><nlm:aff id="A17">University of Texas-Southwestern Medical Center, Dallas, Texas</nlm:aff></affiliation></author><author><name sortKey="Olaison, Lars" sort="Olaison, Lars" uniqKey="Olaison L" first="Lars" last="Olaison">Lars Olaison</name><affiliation><nlm:aff id="A18">Department of Infectious Diseases, Sahlgrenska University Hospital, Göteborg, Sweden</nlm:aff></affiliation></author><author><name sortKey="Wang, Andrew" sort="Wang, Andrew" uniqKey="Wang A" first="Andrew" last="Wang">Andrew Wang</name><affiliation><nlm:aff id="A19">Division of Cardiology, Duke University Medical Center, Durham, NC.</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">20159831</idno><idno type="pmc">3597944</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3597944</idno><idno type="RBID">PMC:3597944</idno><idno type="doi">10.1161/CIRCULATIONAHA.109.864488</idno><date when="2010">2010</date><idno type="wicri:Area/Pmc/Corpus">001C65</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">001C65</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Analysis of the Impact of Early Surgery on In-hospital Mortality of Native Valve Endocarditis: Use of Propensity Score and Instrumental Variable Methods to Adjust for Treatment Selection Bias</title><author><name sortKey="Lalani, Tahaniyat" sort="Lalani, Tahaniyat" uniqKey="Lalani T" first="Tahaniyat" last="Lalani">Tahaniyat Lalani</name><affiliation><nlm:aff id="A1">Duke Clinical Research Institute, Duke University Medical Center, Durham, NC</nlm:aff></affiliation><affiliation><nlm:aff id="A2">Division of Infectious Diseases, Duke University Medical Center, Durham, NC</nlm:aff></affiliation></author><author><name sortKey="Cabell, Christopher H" sort="Cabell, Christopher H" uniqKey="Cabell C" first="Christopher H" last="Cabell">Christopher H. Cabell</name><affiliation><nlm:aff id="A3">Quintiles Translational Corporation, Durham, NC</nlm:aff></affiliation></author><author><name sortKey="Benjamin, Daniel K" sort="Benjamin, Daniel K" uniqKey="Benjamin D" first="Daniel K" last="Benjamin">Daniel K. Benjamin</name><affiliation><nlm:aff id="A4">Clemson University, Clemson, SC</nlm:aff></affiliation></author><author><name sortKey="Lasca, Ovidiu" sort="Lasca, Ovidiu" uniqKey="Lasca O" first="Ovidiu" last="Lasca">Ovidiu Lasca</name><affiliation><nlm:aff id="A4">Clemson University, Clemson, SC</nlm:aff></affiliation></author><author><name sortKey="Naber, Christoph" sort="Naber, Christoph" uniqKey="Naber C" first="Christoph" last="Naber">Christoph Naber</name><affiliation><nlm:aff id="A5">Department of Cardiology, West German Heart Center Essen, University of Duisburg-Essen, Essen, Germany</nlm:aff></affiliation></author><author><name sortKey="Fowler, Vance G" sort="Fowler, Vance G" uniqKey="Fowler V" first="Vance G." last="Fowler">Vance G. Fowler</name><affiliation><nlm:aff id="A1">Duke Clinical Research Institute, Duke University Medical Center, Durham, NC</nlm:aff></affiliation><affiliation><nlm:aff id="A2">Division of Infectious Diseases, Duke University Medical Center, Durham, NC</nlm:aff></affiliation></author><author><name sortKey="Corey, G Ralph" sort="Corey, G Ralph" uniqKey="Corey G" first="G Ralph" last="Corey">G Ralph Corey</name><affiliation><nlm:aff id="A1">Duke Clinical Research Institute, Duke University Medical Center, Durham, NC</nlm:aff></affiliation><affiliation><nlm:aff id="A2">Division of Infectious Diseases, Duke University Medical Center, Durham, NC</nlm:aff></affiliation></author><author><name sortKey="Chu, Vivian H" sort="Chu, Vivian H" uniqKey="Chu V" first="Vivian H" last="Chu">Vivian H. Chu</name><affiliation><nlm:aff id="A1">Duke Clinical Research Institute, Duke University Medical Center, Durham, NC</nlm:aff></affiliation><affiliation><nlm:aff id="A2">Division of Infectious Diseases, Duke University Medical Center, Durham, NC</nlm:aff></affiliation></author><author><name sortKey="Fenely, Michael" sort="Fenely, Michael" uniqKey="Fenely M" first="Michael" last="Fenely">Michael Fenely</name><affiliation><nlm:aff id="A6">St. Vincent's Hospital, Sydney, Australia</nlm:aff></affiliation></author><author><name sortKey="Pachirat, Orathai" sort="Pachirat, Orathai" uniqKey="Pachirat O" first="Orathai" last="Pachirat">Orathai Pachirat</name><affiliation><nlm:aff id="A7">Khon Kaen University, Khon Kaen, Thailand</nlm:aff></affiliation></author><author><name sortKey="Tan, Ru San" sort="Tan, Ru San" uniqKey="Tan R" first="Ru-San" last="Tan">Ru-San Tan</name><affiliation><nlm:aff id="A8">National Heart Center, Singapore</nlm:aff></affiliation></author><author><name sortKey="Watkin, Richard" sort="Watkin, Richard" uniqKey="Watkin R" first="Richard" last="Watkin">Richard Watkin</name><affiliation><nlm:aff id="A9">University of Birmingham, Birmingham, UK</nlm:aff></affiliation></author><author><name sortKey="Ionac, Adina" sort="Ionac, Adina" uniqKey="Ionac A" first="Adina" last="Ionac">Adina Ionac</name><affiliation><nlm:aff id="A10">Victor Babes University of Medicine and Pharmacy, Timisoara, Romania</nlm:aff></affiliation></author><author><name sortKey="Moreno, Asuncion" sort="Moreno, Asuncion" uniqKey="Moreno A" first="Asuncion" last="Moreno">Asuncion Moreno</name><affiliation><nlm:aff id="A11">Hospital Clínic - IDIBAPS, University of Barcelona, Barcelona, Spain</nlm:aff></affiliation></author><author><name sortKey="Mestres, Carlos A" sort="Mestres, Carlos A" uniqKey="Mestres C" first="Carlos A" last="Mestres">Carlos A. Mestres</name><affiliation><nlm:aff id="A11">Hospital Clínic - IDIBAPS, University of Barcelona, Barcelona, Spain</nlm:aff></affiliation></author><author><name sortKey="Casabe, Jose" sort="Casabe, Jose" uniqKey="Casabe J" first="José" last="Casabé">José Casabé</name><affiliation><nlm:aff id="A12">Favaloro University, Instituto de Cardiología y Cirugía Cardiovascular, Buenos Aires, Argentina</nlm:aff></affiliation></author><author><name sortKey="Chipigina, Natalia" sort="Chipigina, Natalia" uniqKey="Chipigina N" first="Natalia" last="Chipigina">Natalia Chipigina</name><affiliation><nlm:aff id="A13">Russian Medical State University, Moscow, Russia</nlm:aff></affiliation></author><author><name sortKey="Eisen, Damon P" sort="Eisen, Damon P" uniqKey="Eisen D" first="Damon P" last="Eisen">Damon P. Eisen</name><affiliation><nlm:aff id="A14">Royal Melbourne Hospital, Victoria, Australia</nlm:aff></affiliation></author><author><name sortKey="Spelman, Denis" sort="Spelman, Denis" uniqKey="Spelman D" first="Denis" last="Spelman">Denis Spelman</name><affiliation><nlm:aff id="A15">Alfred Hospital, Melbourne, Australia</nlm:aff></affiliation></author><author><name sortKey="Delahaye, Francois" sort="Delahaye, Francois" uniqKey="Delahaye F" first="Francois" last="Delahaye">Francois Delahaye</name><affiliation><nlm:aff id="A16">Hosp Louis Pradel, Bron Cedex, France</nlm:aff></affiliation></author><author><name sortKey="Peterson, Gail" sort="Peterson, Gail" uniqKey="Peterson G" first="Gail" last="Peterson">Gail Peterson</name><affiliation><nlm:aff id="A17">University of Texas-Southwestern Medical Center, Dallas, Texas</nlm:aff></affiliation></author><author><name sortKey="Olaison, Lars" sort="Olaison, Lars" uniqKey="Olaison L" first="Lars" last="Olaison">Lars Olaison</name><affiliation><nlm:aff id="A18">Department of Infectious Diseases, Sahlgrenska University Hospital, Göteborg, Sweden</nlm:aff></affiliation></author><author><name sortKey="Wang, Andrew" sort="Wang, Andrew" uniqKey="Wang A" first="Andrew" last="Wang">Andrew Wang</name><affiliation><nlm:aff id="A19">Division of Cardiology, Duke University Medical Center, Durham, NC.</nlm:aff></affiliation></author></analytic><series><title level="j">Circulation</title><idno type="ISSN">0009-7322</idno><idno type="eISSN">1524-4539</idno><imprint><date when="2010">2010</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="S1"><title>Background</title><p id="P1">The impact of early surgery on mortality in patients with native valve endocarditis (NVE) is unresolved. This study seeks to evaluate valve surgery compared to medical therapy for NVE, and to identify characteristics of patients who are most likely to benefit from early surgery.</p></sec><sec id="S2"><title>Methods and Results</title><p id="P2">Using a prospective, multinational cohort of patients with definite NVE, the effect of early surgery on in-hospital mortality was assessed using propensity-based matching adjusting for survivor bias, and instrumental variable analysis. Patients were stratified by propensity quintile, paravalvular complications, valve perforation, systemic embolization, stroke, <italic>Staphylococcus aureus</italic> infection and congestive heart failure.</p><p id="P3">Of the 1552 patients with NVE, 720 (46%) underwent early surgery and 832 (54%) were treated with medical therapy. Compared to medical therapy, early surgery was associated with a significant reduction in mortality in the overall cohort (12.1% [87/720] vs. 20.7% [172/832]) and after propensity-based matching and adjustment for survivor bias (absolute risk reduction (ARR) = -5.9 %; p<0.001). Using a combined instrument, the instrumental variable adjusted ARR in mortality associated with early surgery was -11.2% (p<0.001). In sub-group analysis, surgery was found to confer a survival benefit compared to medical therapy among patients with a higher propensity for surgery (ARR= -10.9% for quintiles 4 and 5; p=0.002); those with paravalvular complications (ARR= -17.3 %; p<0.001), systemic embolization (ARR= -12.9%; p=0.002), <italic>S aureus</italic> NVE (ARR= -20.1%; p<0.001) and stroke (ARR= -13%; p=0.02) but not with valve perforation or congestive heart failure.</p></sec><sec id="S3"><title>Conclusions</title><p id="P4">Early surgery for NVE is associated with an in-hospital mortality benefit compared to medical therapy alone.</p></sec></div></front></TEI><pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<pmc-dir>properties manuscript</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-journal-id">0147763</journal-id><journal-id journal-id-type="pubmed-jr-id">2979</journal-id><journal-id journal-id-type="nlm-ta">Circulation</journal-id><journal-id journal-id-type="iso-abbrev">Circulation</journal-id><journal-title-group><journal-title>Circulation</journal-title></journal-title-group><issn pub-type="ppub">0009-7322</issn><issn pub-type="epub">1524-4539</issn></journal-meta><article-meta><article-id pub-id-type="pmid">20159831</article-id><article-id pub-id-type="pmc">3597944</article-id><article-id pub-id-type="doi">10.1161/CIRCULATIONAHA.109.864488</article-id><article-id pub-id-type="manuscript">NIHMS451199</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Analysis of the Impact of Early Surgery on In-hospital Mortality of Native Valve Endocarditis: Use of Propensity Score and Instrumental Variable Methods to Adjust for Treatment Selection Bias</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Lalani</surname><given-names>Tahaniyat</given-names></name><degrees>MBBS, MHS</degrees><xref ref-type="aff" rid="A1">1</xref><xref ref-type="aff" rid="A2">2</xref></contrib><contrib contrib-type="author"><name><surname>Cabell</surname><given-names>Christopher H</given-names></name><degrees>MD, MHS</degrees><xref ref-type="aff" rid="A3">3</xref></contrib><contrib contrib-type="author"><name><surname>Benjamin</surname><given-names>Daniel K</given-names></name><degrees>PhD</degrees><xref ref-type="aff" rid="A4">4</xref></contrib><contrib contrib-type="author"><name><surname>Lasca</surname><given-names>Ovidiu</given-names></name><degrees>BA</degrees><xref ref-type="aff" rid="A4">4</xref></contrib><contrib contrib-type="author"><name><surname>Naber</surname><given-names>Christoph</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="A5">5</xref></contrib><contrib contrib-type="author"><name><surname>Fowler</surname><given-names>Vance G.</given-names><suffix>Jr.</suffix></name><degrees>MD, MHS</degrees><xref ref-type="aff" rid="A1">1</xref><xref ref-type="aff" rid="A2">2</xref></contrib><contrib contrib-type="author"><name><surname>Corey</surname><given-names>G Ralph</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="A1">1</xref><xref ref-type="aff" rid="A2">2</xref></contrib><contrib contrib-type="author"><name><surname>Chu</surname><given-names>Vivian H</given-names></name><degrees>MD, MHS</degrees><xref ref-type="aff" rid="A1">1</xref><xref ref-type="aff" rid="A2">2</xref></contrib><contrib contrib-type="author"><name><surname>Fenely</surname><given-names>Michael</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="A6">6</xref></contrib><contrib contrib-type="author"><name><surname>Pachirat</surname><given-names>Orathai</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="A7">7</xref></contrib><contrib contrib-type="author"><name><surname>Tan</surname><given-names>Ru-San</given-names></name><degrees>MBBS, MRCP</degrees><xref ref-type="aff" rid="A8">8</xref></contrib><contrib contrib-type="author"><name><surname>Watkin</surname><given-names>Richard</given-names></name><degrees>MRCP</degrees><xref ref-type="aff" rid="A9">9</xref></contrib><contrib contrib-type="author"><name><surname>Ionac</surname><given-names>Adina</given-names></name><degrees>MD, PhD</degrees><xref ref-type="aff" rid="A10">10</xref></contrib><contrib contrib-type="author"><name><surname>Moreno</surname><given-names>Asuncion</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="A11">11</xref></contrib><contrib contrib-type="author"><name><surname>Mestres</surname><given-names>Carlos A</given-names></name><degrees>MD, PhD</degrees><xref ref-type="aff" rid="A11">11</xref></contrib><contrib contrib-type="author"><name><surname>Casabé</surname><given-names>José</given-names></name><degrees>MD, PhD, FACC</degrees><xref ref-type="aff" rid="A12">12</xref></contrib><contrib contrib-type="author"><name><surname>Chipigina</surname><given-names>Natalia</given-names></name><degrees>PhD</degrees><xref ref-type="aff" rid="A13">13</xref></contrib><contrib contrib-type="author"><name><surname>Eisen</surname><given-names>Damon P</given-names></name><degrees>MBBS, MD, FRACP</degrees><xref ref-type="aff" rid="A14">14</xref></contrib><contrib contrib-type="author"><name><surname>Spelman</surname><given-names>Denis</given-names></name><degrees>MBBS, FRACP, FRCPA, MPH</degrees><xref ref-type="aff" rid="A15">15</xref></contrib><contrib contrib-type="author"><name><surname>Delahaye</surname><given-names>Francois</given-names></name><degrees>MD, PhD</degrees><xref ref-type="aff" rid="A16">16</xref></contrib><contrib contrib-type="author"><name><surname>Peterson</surname><given-names>Gail</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="A17">17</xref></contrib><contrib contrib-type="author"><name><surname>Olaison</surname><given-names>Lars</given-names></name><degrees>MD, PhD</degrees><xref ref-type="aff" rid="A18">18</xref></contrib><contrib contrib-type="author"><name><surname>Wang</surname><given-names>Andrew</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="A19">19</xref></contrib><contrib contrib-type="author"><collab>the International Collaboration on Endocarditis-Prospective Cohort Study (ICE-PCS) Investigators</collab></contrib></contrib-group><aff id="A1"><label>1</label>Duke Clinical Research Institute, Duke University Medical Center, Durham, NC</aff><aff id="A2"><label>2</label>Division of Infectious Diseases, Duke University Medical Center, Durham, NC</aff><aff id="A3"><label>3</label>Quintiles Translational Corporation, Durham, NC</aff><aff id="A4"><label>4</label>Clemson University, Clemson, SC</aff><aff id="A5"><label>5</label>Department of Cardiology, West German Heart Center Essen, University of Duisburg-Essen, Essen, Germany</aff><aff id="A6"><label>6</label>St. Vincent's Hospital, Sydney, Australia</aff><aff id="A7"><label>7</label>Khon Kaen University, Khon Kaen, Thailand</aff><aff id="A8"><label>8</label>National Heart Center, Singapore</aff><aff id="A9"><label>9</label>University of Birmingham, Birmingham, UK</aff><aff id="A10"><label>10</label>Victor Babes University of Medicine and Pharmacy, Timisoara, Romania</aff><aff id="A11"><label>11</label>Hospital Clínic - IDIBAPS, University of Barcelona, Barcelona, Spain</aff><aff id="A12"><label>12</label>Favaloro University, Instituto de Cardiología y Cirugía Cardiovascular, Buenos Aires, Argentina</aff><aff id="A13"><label>13</label>Russian Medical State University, Moscow, Russia</aff><aff id="A14"><label>14</label>Royal Melbourne Hospital, Victoria, Australia</aff><aff id="A15"><label>15</label>Alfred Hospital, Melbourne, Australia</aff><aff id="A16"><label>16</label>Hosp Louis Pradel, Bron Cedex, France</aff><aff id="A17"><label>17</label>University of Texas-Southwestern Medical Center, Dallas, Texas</aff><aff id="A18"><label>18</label>Department of Infectious Diseases, Sahlgrenska University Hospital, Göteborg, Sweden</aff><aff id="A19"><label>19</label>Division of Cardiology, Duke University Medical Center, Durham, NC.</aff><author-notes><corresp id="CR1"><bold>Corresponding author:</bold> Tahaniyat Lalani, Naval Medical Center Portsmouth, Building 3-1<sup>st</sup> Floor, 620 John Paul Jones Circle, Portsmouth, VA 23708 <email>tlalani@idcrp.org</email> Telephone: (757) 953 5659 Fax: (757) 953 5514</corresp></author-notes><pub-date pub-type="nihms-submitted"><day>8</day><month>3</month><year>2013</year></pub-date><pub-date pub-type="epub"><day>16</day><month>2</month><year>2010</year></pub-date><pub-date pub-type="ppub"><day>2</day><month>3</month><year>2010</year></pub-date><pub-date pub-type="pmc-release"><day>15</day><month>3</month><year>2013</year></pub-date><volume>121</volume><issue>8</issue><fpage>1005</fpage><lpage>1013</lpage><abstract><sec id="S1"><title>Background</title><p id="P1">The impact of early surgery on mortality in patients with native valve endocarditis (NVE) is unresolved. This study seeks to evaluate valve surgery compared to medical therapy for NVE, and to identify characteristics of patients who are most likely to benefit from early surgery.</p></sec><sec id="S2"><title>Methods and Results</title><p id="P2">Using a prospective, multinational cohort of patients with definite NVE, the effect of early surgery on in-hospital mortality was assessed using propensity-based matching adjusting for survivor bias, and instrumental variable analysis. Patients were stratified by propensity quintile, paravalvular complications, valve perforation, systemic embolization, stroke, <italic>Staphylococcus aureus</italic> infection and congestive heart failure.</p><p id="P3">Of the 1552 patients with NVE, 720 (46%) underwent early surgery and 832 (54%) were treated with medical therapy. Compared to medical therapy, early surgery was associated with a significant reduction in mortality in the overall cohort (12.1% [87/720] vs. 20.7% [172/832]) and after propensity-based matching and adjustment for survivor bias (absolute risk reduction (ARR) = -5.9 %; p<0.001). Using a combined instrument, the instrumental variable adjusted ARR in mortality associated with early surgery was -11.2% (p<0.001). In sub-group analysis, surgery was found to confer a survival benefit compared to medical therapy among patients with a higher propensity for surgery (ARR= -10.9% for quintiles 4 and 5; p=0.002); those with paravalvular complications (ARR= -17.3 %; p<0.001), systemic embolization (ARR= -12.9%; p=0.002), <italic>S aureus</italic> NVE (ARR= -20.1%; p<0.001) and stroke (ARR= -13%; p=0.02) but not with valve perforation or congestive heart failure.</p></sec><sec id="S3"><title>Conclusions</title><p id="P4">Early surgery for NVE is associated with an in-hospital mortality benefit compared to medical therapy alone.</p></sec></abstract><kwd-group><kwd>early surgery</kwd><kwd>infective endocarditis</kwd><kwd>medical therapy</kwd><kwd>in hospital mortality</kwd></kwd-group><funding-group><award-group><funding-source country="United States">National Institute of Allergy and Infectious Diseases Extramural Activities : NIAID</funding-source><award-id>R01 AI068804 || AI</award-id></award-group></funding-group></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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