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dc.contributor.author Wang, Andrew
dc.contributor.author Cabell, Christopher Hayden
dc.contributor.author Lalani, Tahaniyat
dc.contributor.author Benjamin, Daniel Kelly
dc.contributor.author Fowler, Vance Garrison Jr.
dc.contributor.author Corey, Ralph
dc.contributor.author Chu, Vivian Hou
dc.date.accessioned 2012-10-30T19:29:43Z
dc.date.available 2012-10-30T19:29:43Z
dc.date.issued 2010-03
dc.identifier.citation Lalani, T., C. H. Cabell, et al. (2010). "Analysis of the Impact of Early Surgery on In-Hospital Mortality of Native Valve Endocarditis." Circulation 121(8): 1005-1013. en_US
dc.identifier.uri http://hdl.handle.net/10161/5963
dc.description.abstract Background— The impact of early surgery on mortality in patients with native valve endocarditis (NVE) is unresolved. This study sought to evaluate valve surgery compared with medical therapy for NVE and to identify characteristics of patients who are most likely to benefit from early surgery. Methods and Results— Using a prospective, multinational cohort of patients with definite NVE, the effect of early surgery on in-hospital mortality was assessed by propensity-based matching adjustment for survivor bias and by instrumental variable analysis. Patients were stratified by propensity quintile, paravalvular complications, valve perforation, systemic embolization, stroke, Staphylococcus aureus infection, and congestive heart failure. Of the 1552 patients with NVE, 720 (46%) underwent early surgery and 832 (54%) were treated with medical therapy. Compared with medical therapy, early surgery was associated with a significant reduction in mortality in the overall cohort (12.1% [87/720] versus 20.7% [172/832]) and after propensity-based matching and adjustment for survivor bias (absolute risk reduction [ARR] −5.9%, P<0.001). With a combined instrument, the instrumental-variable–adjusted ARR in mortality associated with early surgery was −11.2% (P<0.001). In subgroup analysis, surgery was found to confer a survival benefit compared with medical therapy among patients with a higher propensity for surgery (ARR −10.9% for quintiles 4 and 5, P=0.002) and those with paravalvular complications (ARR −17.3%, P<0.001), systemic embolization (ARR −12.9%, P=0.002), S aureus NVE (ARR −20.1%, P<0.001), and stroke (ARR −13%, P=0.02) but not those with valve perforation or congestive heart failure. Conclusions— Early surgery for NVE is associated with an in-hospital mortality benefit compared with medical therapy alone. en_US
dc.publisher American Heart Association en_US
dc.relation.isversionof doi:10.1161/CIRCULATIONAHA.109.864488 en_US
dc.subject surgery en_US
dc.subject endocarditis en_US
dc.subject drug therapy en_US
dc.subject hospital mortality en_US
dc.title Analysis of the Impact of Early Surgery on In-Hospital Mortality of Native Valve Endocarditis en_US
dc.type Article en_US
duke.description.endpage 1013 en_US
duke.description.issue 8 en_US
duke.description.startpage 1005 en_US
duke.description.volume 121 en_US
dc.relation.journal Circulation en_US

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