The Journal of thoracic and cardiovascular surgery · 2025
Early extraction versus conservative management in patients with noninfected cardiac implantable electronic devices undergoing cardiac surgery for left-sided infective endocarditis: Insights from the multicentric Clinical Multicenter Project for Analysis of Infective Endocarditis in Germany Registry.
СтатьяМногоцентровое исследованиеСравнительное исследованиеНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Marin-Cuartas Mateo, Dietze Zara, Freiburger Sebastian, Weber Carolyn, Luehr Maximilian, De La Cuesta Manuela, Drywa Gottfried T, Stöger Guillermo, Saha Shekhar, Petrov Asen, Lichtenberg Artur, Hagl Christian, Aubin Hug, Matschke Klaus, Diab Mahmoud, Akhyari Payam, Tugtekin Sems-Malte, Wahlers Thorsten, Conradi Lenard, Morjan Mohammed, Dashkewich Alexey, Holzhey David, Kiefer Philipp, Misfeld Martin, de Waha Suzanne, Doenst Torsten, Borger Michael A
Аннотация
OBJECTIVES: This study aimed to analyze the outcomes of patients with left-sided infective endocarditis (IE) and noninfected cardiac implantable electronic device (CIED) undergoing cardiac surgery, with a focus on whether the CIED was removed.
METHODS: Retrospective analysis based on the Clinical Multicenter Project for Analysis of Infective Endocarditis in Germany Registry, comprising patients with left-sided IE who underwent valve surgery between 1994 and 2018 in 6 German centers. Two treatment strategies were compared: CIED extraction versus no extraction. The primary outcomes were 30-day mortality, long-term survival, and recurrent IE rates. Propensity score matching was performed to account for baseline differences.
RESULTS: From a total of 4917 registry patients, 245 met the inclusion criteria. The CIED was not extracted in 145 (59.1%) patients and extracted in 100 (40.8%) patients, with propensity score matching resulting in 74 similar pairs. The 30-day mortality was 13.5% versus 20.3% in the extraction and nonextraction groups, respectively (P = .23). Intensive care unit (median, 4 vs 8 days; P = .003) and hospital stays (median, 17 vs 24 days; P < .001) were significantly longer in the extraction group. The estimated 8-year survival was 31.5% versus 28.6% in the extraction and nonextraction groups, respectively (subdistribution hazard ratio, 0.8; 95% CI, 0.5-1.2; P = .26). The estimated recurrent IE rate at 6 months was 3.5% versus 4.7%, and at 8 years, 5.4% versus 11.3%, in the extraction and nonextraction groups, respectively (subdistribution hazard ratio, 0.43; 95% CI, 0.1-1.7; P = .24).
CONCLUSIONS: In patients with left-sided IE and noninfected CIED undergoing cardiac surgery, CIED extraction was not associated with a survival advantage or lower recurrent IE rates, but with longer intensive care unit and hospital stays.
METHODS: Retrospective analysis based on the Clinical Multicenter Project for Analysis of Infective Endocarditis in Germany Registry, comprising patients with left-sided IE who underwent valve surgery between 1994 and 2018 in 6 German centers. Two treatment strategies were compared: CIED extraction versus no extraction. The primary outcomes were 30-day mortality, long-term survival, and recurrent IE rates. Propensity score matching was performed to account for baseline differences.
RESULTS: From a total of 4917 registry patients, 245 met the inclusion criteria. The CIED was not extracted in 145 (59.1%) patients and extracted in 100 (40.8%) patients, with propensity score matching resulting in 74 similar pairs. The 30-day mortality was 13.5% versus 20.3% in the extraction and nonextraction groups, respectively (P = .23). Intensive care unit (median, 4 vs 8 days; P = .003) and hospital stays (median, 17 vs 24 days; P < .001) were significantly longer in the extraction group. The estimated 8-year survival was 31.5% versus 28.6% in the extraction and nonextraction groups, respectively (subdistribution hazard ratio, 0.8; 95% CI, 0.5-1.2; P = .26). The estimated recurrent IE rate at 6 months was 3.5% versus 4.7%, and at 8 years, 5.4% versus 11.3%, in the extraction and nonextraction groups, respectively (subdistribution hazard ratio, 0.43; 95% CI, 0.1-1.7; P = .24).
CONCLUSIONS: In patients with left-sided IE and noninfected CIED undergoing cardiac surgery, CIED extraction was not associated with a survival advantage or lower recurrent IE rates, but with longer intensive care unit and hospital stays.