Long-term outcome of infective endocarditis: The impact of early surgical intervention

To determine the impact of early surgical intervention on long-term surviva l in patients with infective endocarditis (IE), charts of all patients who had IE from January 1987 through December 1996 were reviewed. A total of 25 2 patients with definite or possible IE were included. Forty-four patients (17.5%) had early surgery on median hospital day 2 (range, 0-30 days), and 208 patients (82.5%) received medical treatment alone. On multivariate anal ysis, several variables, including early surgical intervention, improved lo ng-term survival rates (hazard ratio, 1.5; P=.03), mainly in patients with Staphylococcus aureus etiology (P=.04). When patients with prosthetic devic es were excluded, the median duration of survival for patients who had earl y surgery was >150 months, compared with 61.5 months for patients in the me dical group (P=.1). Early surgical intervention compared with medical thera py alone is associated with increased short- and long-term survival rates i n patients with IE, primarily when IE is caused by S. aureus.