Early Surgery No Benefit in Prosthetic Valve Endocarditis
(HealthDay News) – For patients with prosthetic valve endocarditis (PVE), early valve replacement is not associated with lower mortality vs. medical therapy, after adjustment for clinical characteristics and survival bias, according to a study published online July 15 in JAMA Internal Medicine.
Tahaniyat Lalani, MD, MHS, from the Infectious Disease Clinical Research Program in Bethesda, MD, and colleagues examined in-hospital and one-year mortality among patients with PVE who underwent valve replacement during index hospitalization (490 patients) vs. those treated with medical therapy alone (535 patients).
The researchers found that in unadjusted analyses and after controlling for treatment selection bias, early surgery correlated with lower in-hospital mortality (hazard ratio, 0.44) and lower one-year mortality (hazard ratio, 0.57), compared with medical therapy alone. After adjustment for survivor bias, the correlations were no longer significant. In subgroup analyses, patients in the highest quintile of surgical propensity had significantly lower in-hospital mortality with early surgery (21.2% vs. 37.5%). At one-year follow-up, significantly reduced mortality was seen for those in the fourth and fifth quintiles of surgical propensity who underwent early surgery.
"Prosthetic valve endocarditis remains associated with a high one-year mortality rate," the authors write. "After adjustment for differences in clinical characteristics and survival bias, early valve replacement was not associated with lower mortality compared with medical therapy in the overall cohort."