TY - JOUR 
A1 - Martínez Sellés Oliveria Soares, Manuel
AU - Muñoz, Patricia
AU - Arnáiz, Ana María
AU - Moreno, Mar
AU - Gálvez-Acebal, Juan
AU - Rodríguez-Roda, Jorge R.
AU - Alarcón González, Arístides de
AU - García-Cabrera, Emilio
AU - Fariñas, María Carmen
AU - Miró, J. M.
AU - Montejo, Miguel L.
AU - Moreno, Alfonso Soto
AU - Ruiz-Morales, Josefa
AU - Goenaga, Miguel Ángel
AU - Bouza, Emilio
T1 - Valve surgery in active infective endocarditis: a simple score to predict in-hospital prognosis
Y1 - 2014
SN - 01675273
UR - http://hdl.handle.net/11268/4016
AB - Aims
Surgery for infective endocarditis (IE) is associated with high mortality. Our objectives were to describe the experience with surgical treatment for IE in Spain, and to identify predictors of in-hospital mortality.

Methods
Prospective cohort of 1000 consecutive patients with IE. Data were collected in 26 Spanish hospitals.

Results
Surgery was performed in 437 patients (43.7%). Patients treated with surgery were younger and predominantly male. They presented fewer comorbid conditions and more often had negative blood cultures and heart failure. In-hospital mortality after surgery was lower than in the medical therapy group (24.3 vs 30.7%, p = 0.02). In patients treated with surgery, endocarditis involved a native valve in 267 patients (61.1%), a prosthetic valve in 122 (27.9%), and a pacemaker lead with no clear further valve involvement in 48 (11.0%). The most common aetiologies were Staphylococcus (186, 42.6%), Streptococcus (97, 22.2%), and Enterococcus (49, 11.2%). The main indications for surgery were heart failure and severe valve regurgitation. A risk score for in-hospital mortality was developed using 7 prognostic variables with a similar predictive value (OR between 1.7 and 2.3): PALSUSE: prosthetic valve, age ≥ 70, large intracardiac destruction, Staphylococcus spp, urgent surgery, sex [female], EuroSCORE ≥ 10. In-hospital mortality ranged from 0% in patients with a PALSUSE score of 0 to 45.4% in patients with PALSUSE score > 3.

Conclusions
The prognosis of IE surgery is highly variable. The PALSUSE score could help to identify patients with higher in-hospital mortality.
KW - Endocarditis infecciosa
KW - Estratificación de riesgos
KW - Cardiología
KW - Sistema cardiovascular
LA - eng
ER -