The impact of valve surgery on 6-month mortality in left-sided infective endocarditis

Imad M. Tleyjeh, Hassan M K Ghomrawi, James M. Steckelberg, Tanya L. Hoskin, Zaur Mirzoyev, Nandan S. Anavekar, Felicity T Enders, Sherif Moustafa, Farouk Mookadam, W Charles Huskins, Walter R. Wilson, Larry M. Baddour

Research output: Contribution to journalArticle

97 Citations (Scopus)

Abstract

BACKGROUND - The role of valve surgery in left-sided infective endocarditis has not been evaluated in randomized controlled trials. We examined the association between valve surgery and all-cause 6-month mortality among patients with left-sided infective endocarditis. METHODS AND RESULTS - A total of 546 consecutive patients with left-sided infective endocarditis were included. To minimize selection bias, propensity score to undergo valve surgery was used to match patients in the surgical and nonsurgical groups. To adjust for survivor bias, we matched the follow-up time so that each patient in the nonsurgical group survived at least as long as the time to surgery in the respective surgically-treated patient. We also used valve surgery as a time-dependent covariate in different Cox models. A total of 129 (23.6%) patients underwent surgery within 30 days of diagnosis. Death occurred in 99 of the 417 patients (23.7%) in the nonsurgical group versus 35 deaths among the 129 patients (27.1%) in the surgical group. Eighteen of 35 (51%) patients in the surgical group died within 7 days of valve surgery. In the subset of 186 cases (93 pairs of surgical versus nonsurgical cases) matched on the logit of their propensity score, diagnosis decade, and follow-up time, no significant association existed between surgery and mortality (adjusted hazard ratio, 1.3; 95% confidence interval, 0.5 to 3.1). With a Cox model that incorporated surgery as a time-dependent covariate, valve surgery was associated with an increase in the 6-month mortality with an adjusted hazard ratio of 1.9 (95% confidence interval, 1.1 to 3.2). Because the proportionality hazard assumption was violated in the time-dependent analysis, we performed a partitioning analysis. After adjustment for early (operative) mortality, surgery was not associated with a survival benefit (adjusted hazard ratio, 0.92; 95% confidence interval, 0.48 to 1.76). CONCLUSIONS - The results of our study suggest that valve surgery in left-sided infective endocarditis is not associated with a survival benefit and could be associated with increased 6-month mortality, even after adjustment for selection and survivor biases as well as confounders. Given the disparity between the results of our study and those of other observational studies, well-designed prospective studies are needed to further evaluate the role of valve surgery in endocarditis management.

Original languageEnglish (US)
Pages (from-to)1721-1728
Number of pages8
JournalCirculation
Volume115
Issue number13
DOIs
StatePublished - Apr 2007

Fingerprint

Endocarditis
Mortality
Propensity Score
Selection Bias
Confidence Intervals
Proportional Hazards Models
Survivors
Survival
Ambulatory Surgical Procedures
Observational Studies
Randomized Controlled Trials
Prospective Studies

Keywords

  • Endocarditis
  • Infection
  • Surgery
  • Valves

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Tleyjeh, I. M., Ghomrawi, H. M. K., Steckelberg, J. M., Hoskin, T. L., Mirzoyev, Z., Anavekar, N. S., ... Baddour, L. M. (2007). The impact of valve surgery on 6-month mortality in left-sided infective endocarditis. Circulation, 115(13), 1721-1728. https://doi.org/10.1161/CIRCULATIONAHA.106.658831

The impact of valve surgery on 6-month mortality in left-sided infective endocarditis. / Tleyjeh, Imad M.; Ghomrawi, Hassan M K; Steckelberg, James M.; Hoskin, Tanya L.; Mirzoyev, Zaur; Anavekar, Nandan S.; Enders, Felicity T; Moustafa, Sherif; Mookadam, Farouk; Huskins, W Charles; Wilson, Walter R.; Baddour, Larry M.

In: Circulation, Vol. 115, No. 13, 04.2007, p. 1721-1728.

Research output: Contribution to journalArticle

Tleyjeh, IM, Ghomrawi, HMK, Steckelberg, JM, Hoskin, TL, Mirzoyev, Z, Anavekar, NS, Enders, FT, Moustafa, S, Mookadam, F, Huskins, WC, Wilson, WR & Baddour, LM 2007, 'The impact of valve surgery on 6-month mortality in left-sided infective endocarditis', Circulation, vol. 115, no. 13, pp. 1721-1728. https://doi.org/10.1161/CIRCULATIONAHA.106.658831
Tleyjeh IM, Ghomrawi HMK, Steckelberg JM, Hoskin TL, Mirzoyev Z, Anavekar NS et al. The impact of valve surgery on 6-month mortality in left-sided infective endocarditis. Circulation. 2007 Apr;115(13):1721-1728. https://doi.org/10.1161/CIRCULATIONAHA.106.658831
Tleyjeh, Imad M. ; Ghomrawi, Hassan M K ; Steckelberg, James M. ; Hoskin, Tanya L. ; Mirzoyev, Zaur ; Anavekar, Nandan S. ; Enders, Felicity T ; Moustafa, Sherif ; Mookadam, Farouk ; Huskins, W Charles ; Wilson, Walter R. ; Baddour, Larry M. / The impact of valve surgery on 6-month mortality in left-sided infective endocarditis. In: Circulation. 2007 ; Vol. 115, No. 13. pp. 1721-1728.
@article{ccb71f6e968742e8ad7b3ad32acf695d,
title = "The impact of valve surgery on 6-month mortality in left-sided infective endocarditis",
abstract = "BACKGROUND - The role of valve surgery in left-sided infective endocarditis has not been evaluated in randomized controlled trials. We examined the association between valve surgery and all-cause 6-month mortality among patients with left-sided infective endocarditis. METHODS AND RESULTS - A total of 546 consecutive patients with left-sided infective endocarditis were included. To minimize selection bias, propensity score to undergo valve surgery was used to match patients in the surgical and nonsurgical groups. To adjust for survivor bias, we matched the follow-up time so that each patient in the nonsurgical group survived at least as long as the time to surgery in the respective surgically-treated patient. We also used valve surgery as a time-dependent covariate in different Cox models. A total of 129 (23.6{\%}) patients underwent surgery within 30 days of diagnosis. Death occurred in 99 of the 417 patients (23.7{\%}) in the nonsurgical group versus 35 deaths among the 129 patients (27.1{\%}) in the surgical group. Eighteen of 35 (51{\%}) patients in the surgical group died within 7 days of valve surgery. In the subset of 186 cases (93 pairs of surgical versus nonsurgical cases) matched on the logit of their propensity score, diagnosis decade, and follow-up time, no significant association existed between surgery and mortality (adjusted hazard ratio, 1.3; 95{\%} confidence interval, 0.5 to 3.1). With a Cox model that incorporated surgery as a time-dependent covariate, valve surgery was associated with an increase in the 6-month mortality with an adjusted hazard ratio of 1.9 (95{\%} confidence interval, 1.1 to 3.2). Because the proportionality hazard assumption was violated in the time-dependent analysis, we performed a partitioning analysis. After adjustment for early (operative) mortality, surgery was not associated with a survival benefit (adjusted hazard ratio, 0.92; 95{\%} confidence interval, 0.48 to 1.76). CONCLUSIONS - The results of our study suggest that valve surgery in left-sided infective endocarditis is not associated with a survival benefit and could be associated with increased 6-month mortality, even after adjustment for selection and survivor biases as well as confounders. Given the disparity between the results of our study and those of other observational studies, well-designed prospective studies are needed to further evaluate the role of valve surgery in endocarditis management.",
keywords = "Endocarditis, Infection, Surgery, Valves",
author = "Tleyjeh, {Imad M.} and Ghomrawi, {Hassan M K} and Steckelberg, {James M.} and Hoskin, {Tanya L.} and Zaur Mirzoyev and Anavekar, {Nandan S.} and Enders, {Felicity T} and Sherif Moustafa and Farouk Mookadam and Huskins, {W Charles} and Wilson, {Walter R.} and Baddour, {Larry M.}",
year = "2007",
month = "4",
doi = "10.1161/CIRCULATIONAHA.106.658831",
language = "English (US)",
volume = "115",
pages = "1721--1728",
journal = "Circulation",
issn = "0009-7322",
publisher = "Lippincott Williams and Wilkins",
number = "13",

}

TY - JOUR

T1 - The impact of valve surgery on 6-month mortality in left-sided infective endocarditis

AU - Tleyjeh, Imad M.

AU - Ghomrawi, Hassan M K

AU - Steckelberg, James M.

AU - Hoskin, Tanya L.

AU - Mirzoyev, Zaur

AU - Anavekar, Nandan S.

AU - Enders, Felicity T

AU - Moustafa, Sherif

AU - Mookadam, Farouk

AU - Huskins, W Charles

AU - Wilson, Walter R.

AU - Baddour, Larry M.

PY - 2007/4

Y1 - 2007/4

N2 - BACKGROUND - The role of valve surgery in left-sided infective endocarditis has not been evaluated in randomized controlled trials. We examined the association between valve surgery and all-cause 6-month mortality among patients with left-sided infective endocarditis. METHODS AND RESULTS - A total of 546 consecutive patients with left-sided infective endocarditis were included. To minimize selection bias, propensity score to undergo valve surgery was used to match patients in the surgical and nonsurgical groups. To adjust for survivor bias, we matched the follow-up time so that each patient in the nonsurgical group survived at least as long as the time to surgery in the respective surgically-treated patient. We also used valve surgery as a time-dependent covariate in different Cox models. A total of 129 (23.6%) patients underwent surgery within 30 days of diagnosis. Death occurred in 99 of the 417 patients (23.7%) in the nonsurgical group versus 35 deaths among the 129 patients (27.1%) in the surgical group. Eighteen of 35 (51%) patients in the surgical group died within 7 days of valve surgery. In the subset of 186 cases (93 pairs of surgical versus nonsurgical cases) matched on the logit of their propensity score, diagnosis decade, and follow-up time, no significant association existed between surgery and mortality (adjusted hazard ratio, 1.3; 95% confidence interval, 0.5 to 3.1). With a Cox model that incorporated surgery as a time-dependent covariate, valve surgery was associated with an increase in the 6-month mortality with an adjusted hazard ratio of 1.9 (95% confidence interval, 1.1 to 3.2). Because the proportionality hazard assumption was violated in the time-dependent analysis, we performed a partitioning analysis. After adjustment for early (operative) mortality, surgery was not associated with a survival benefit (adjusted hazard ratio, 0.92; 95% confidence interval, 0.48 to 1.76). CONCLUSIONS - The results of our study suggest that valve surgery in left-sided infective endocarditis is not associated with a survival benefit and could be associated with increased 6-month mortality, even after adjustment for selection and survivor biases as well as confounders. Given the disparity between the results of our study and those of other observational studies, well-designed prospective studies are needed to further evaluate the role of valve surgery in endocarditis management.

AB - BACKGROUND - The role of valve surgery in left-sided infective endocarditis has not been evaluated in randomized controlled trials. We examined the association between valve surgery and all-cause 6-month mortality among patients with left-sided infective endocarditis. METHODS AND RESULTS - A total of 546 consecutive patients with left-sided infective endocarditis were included. To minimize selection bias, propensity score to undergo valve surgery was used to match patients in the surgical and nonsurgical groups. To adjust for survivor bias, we matched the follow-up time so that each patient in the nonsurgical group survived at least as long as the time to surgery in the respective surgically-treated patient. We also used valve surgery as a time-dependent covariate in different Cox models. A total of 129 (23.6%) patients underwent surgery within 30 days of diagnosis. Death occurred in 99 of the 417 patients (23.7%) in the nonsurgical group versus 35 deaths among the 129 patients (27.1%) in the surgical group. Eighteen of 35 (51%) patients in the surgical group died within 7 days of valve surgery. In the subset of 186 cases (93 pairs of surgical versus nonsurgical cases) matched on the logit of their propensity score, diagnosis decade, and follow-up time, no significant association existed between surgery and mortality (adjusted hazard ratio, 1.3; 95% confidence interval, 0.5 to 3.1). With a Cox model that incorporated surgery as a time-dependent covariate, valve surgery was associated with an increase in the 6-month mortality with an adjusted hazard ratio of 1.9 (95% confidence interval, 1.1 to 3.2). Because the proportionality hazard assumption was violated in the time-dependent analysis, we performed a partitioning analysis. After adjustment for early (operative) mortality, surgery was not associated with a survival benefit (adjusted hazard ratio, 0.92; 95% confidence interval, 0.48 to 1.76). CONCLUSIONS - The results of our study suggest that valve surgery in left-sided infective endocarditis is not associated with a survival benefit and could be associated with increased 6-month mortality, even after adjustment for selection and survivor biases as well as confounders. Given the disparity between the results of our study and those of other observational studies, well-designed prospective studies are needed to further evaluate the role of valve surgery in endocarditis management.

KW - Endocarditis

KW - Infection

KW - Surgery

KW - Valves

UR - http://www.scopus.com/inward/record.url?scp=34247274099&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=34247274099&partnerID=8YFLogxK

U2 - 10.1161/CIRCULATIONAHA.106.658831

DO - 10.1161/CIRCULATIONAHA.106.658831

M3 - Article

C2 - 17372170

AN - SCOPUS:34247274099

VL - 115

SP - 1721

EP - 1728

JO - Circulation

JF - Circulation

SN - 0009-7322

IS - 13

ER -