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17-11-2011 | Cardiology | Article

Early surgery reduces serious complications in endocarditis

Abstract

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MedWire News: Early surgery for infective endocarditis (IE) significantly reduces the risk for in-hospital death and acute embolic events compared with standard medical treatment, results from the EASE trial suggest.

"We found that early surgery - within 48 hours of diagnosis of IE - is clinically feasible," said study investigator Duk-Hyun Kang, from the University of Ulsan in Seoul, Korea, adding: "Additional large randomized trials are needed to evaluate the role of surgery in complicated IE."

The Early Surgery Versus Conventional Treatment for Infective Endocarditis (EASE) trial compared early surgery with conventional treatment in patients with IE, an area of ongoing controversy.

Kang's team recruited 134 patients, aged 47 years on average, with definite IE, of whom 76 were eligible for randomization. Most of the participants were men (67%), the mean vegetation diameter was 13.8 mm, and the most common infective microorganism was streptococcus (60.5%).

Patients were randomly assigned to conventional medical treatment with antibiotics (plus surgery, if necessary), or early surgery to remove infected tissue and repair damage within 48 hours of diagnosis.

In the standard care group, 27 patients underwent surgery during initial hospitalization and three patients underwent surgery after initial hospital discharge but before the 6-month follow-up.

The study's primary endpoint was a composite of in-hospital death and embolic events at 6 weeks and the key secondary endpoint was a composite of all-cause death, embolic events, and IE recurrence at 6 months. Early surgery significantly reduced the incidence of both these endpoints as compared with standard treatment, by 75% and 92%, respectively.

When all-cause mortality was considered as a separate outcome, there was no significant difference between the two groups at 6 months, with rates of 2.7% in the early surgery group and 5.1% in the conventional treatment group.

Kang acknowledged the small size of the study and said that further work is needed to confirm and endorse their results. Nevertheless, he said the findings suggest that early surgery "can be an option to further improve clinical outcome in IE, which is associated with considerable mortality and morbidity that has not improved significantly despite advances in medical and surgical treatment."

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

By Helen Albert

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