The Dilemma of Surgical Timing in Acute Aortic Valve Endocarditis: Does Early Surgery Improve Risks or Prognosis?
Background: Acute aortic valve infective endocarditis (IE) presents a critical surgical timing dilemma. This study investigates whether early surgical intervention (within seven days of targeted antibiotic therapy initiation) affects mortality and clinical outcomes compared to delayed/conventional s...
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MDPI AG
2025-04-01
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| Series: | Journal of Cardiovascular Development and Disease |
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| Online Access: | https://www.mdpi.com/2308-3425/12/4/153 |
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| author | Michele D’Alonzo Lorenzo Di Bacco Antonio Fiore Massimo Baudo Francesca Zanin Chiara Baldelli Cyrus Moini Thierry Folliguet Claudio Muneretto |
| author_facet | Michele D’Alonzo Lorenzo Di Bacco Antonio Fiore Massimo Baudo Francesca Zanin Chiara Baldelli Cyrus Moini Thierry Folliguet Claudio Muneretto |
| author_sort | Michele D’Alonzo |
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| description | Background: Acute aortic valve infective endocarditis (IE) presents a critical surgical timing dilemma. This study investigates whether early surgical intervention (within seven days of targeted antibiotic therapy initiation) affects mortality and clinical outcomes compared to delayed/conventional surgery. Methods: A retrospective, multicenter analysis of 204 patients with aortic IE was conducted, excluding emergency cases requiring immediate intervention. Patients were stratified into EARLY (≤7 days) and LATE (>7 days) surgical groups. Primary endpoints included in-hospital mortality and major adverse events, while secondary endpoints assessed long-term survival, recurrence, and reintervention rates. Results: No significant differences in in-hospital mortality were observed between groups (16% in both). The LATE group exhibited a trend toward increased permanent pacemaker implantation (16% vs. 8.2%; <i>p</i> = 0.100) and a higher incidence of postoperative atrial fibrillation (36% vs. 24%, <i>p</i> = 0.048). Infective endocarditis recurrence and long-term survival did not significantly differ between groups. Predictors of one-year mortality included chronic kidney disease, annular abscess, extracorporeal membrane oxygenation (ECMO) use, and prolonged mechanical ventilation. Conclusions: These findings suggest that early surgery, following a short course of antibiotics, does not compromise outcomes nor increase recurrence risk, challenging the conventional preference for delayed intervention in non-emergency IE cases. |
| format | Article |
| id | doaj-art-206b3aa21dbe46efa7b39ef61cf5bd06 |
| institution | OA Journals |
| issn | 2308-3425 |
| language | English |
| publishDate | 2025-04-01 |
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| series | Journal of Cardiovascular Development and Disease |
| spelling | doaj-art-206b3aa21dbe46efa7b39ef61cf5bd062025-08-20T02:18:09ZengMDPI AGJournal of Cardiovascular Development and Disease2308-34252025-04-0112415310.3390/jcdd12040153The Dilemma of Surgical Timing in Acute Aortic Valve Endocarditis: Does Early Surgery Improve Risks or Prognosis?Michele D’Alonzo0Lorenzo Di Bacco1Antonio Fiore2Massimo Baudo3Francesca Zanin4Chiara Baldelli5Cyrus Moini6Thierry Folliguet7Claudio Muneretto8Cardiac Surgery Unit, University of Brescia, “Spedali Civili” Hospital, 25124 Brescia, ItalyCardiac Surgery Unit, University of Brescia, “Spedali Civili” Hospital, 25124 Brescia, ItalyCardiac Surgery Unit, Hôpital “Henri Mondor—Assistance Publique Hôpîtaux de Paris”, 94100 Créteil, FranceDepartment of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, PA 19096, USACardiac Surgery Unit, University of Brescia, “Spedali Civili” Hospital, 25124 Brescia, ItalySchool of Medicine and Surgery, University of Brescia, 25124 Brescia, ItalyDepartment of Cardiology, Groupe Hospitalier Sud Ile de France, 77000 Melun, FranceCardiac Surgery Unit, Hôpital “Henri Mondor—Assistance Publique Hôpîtaux de Paris”, 94100 Créteil, FranceCardiac Surgery Unit, University of Brescia, “Spedali Civili” Hospital, 25124 Brescia, ItalyBackground: Acute aortic valve infective endocarditis (IE) presents a critical surgical timing dilemma. This study investigates whether early surgical intervention (within seven days of targeted antibiotic therapy initiation) affects mortality and clinical outcomes compared to delayed/conventional surgery. Methods: A retrospective, multicenter analysis of 204 patients with aortic IE was conducted, excluding emergency cases requiring immediate intervention. Patients were stratified into EARLY (≤7 days) and LATE (>7 days) surgical groups. Primary endpoints included in-hospital mortality and major adverse events, while secondary endpoints assessed long-term survival, recurrence, and reintervention rates. Results: No significant differences in in-hospital mortality were observed between groups (16% in both). The LATE group exhibited a trend toward increased permanent pacemaker implantation (16% vs. 8.2%; <i>p</i> = 0.100) and a higher incidence of postoperative atrial fibrillation (36% vs. 24%, <i>p</i> = 0.048). Infective endocarditis recurrence and long-term survival did not significantly differ between groups. Predictors of one-year mortality included chronic kidney disease, annular abscess, extracorporeal membrane oxygenation (ECMO) use, and prolonged mechanical ventilation. Conclusions: These findings suggest that early surgery, following a short course of antibiotics, does not compromise outcomes nor increase recurrence risk, challenging the conventional preference for delayed intervention in non-emergency IE cases.https://www.mdpi.com/2308-3425/12/4/153infective endocarditisaortic valvehomograftearly treatmenttimingantibiotics |
| spellingShingle | Michele D’Alonzo Lorenzo Di Bacco Antonio Fiore Massimo Baudo Francesca Zanin Chiara Baldelli Cyrus Moini Thierry Folliguet Claudio Muneretto The Dilemma of Surgical Timing in Acute Aortic Valve Endocarditis: Does Early Surgery Improve Risks or Prognosis? Journal of Cardiovascular Development and Disease infective endocarditis aortic valve homograft early treatment timing antibiotics |
| title | The Dilemma of Surgical Timing in Acute Aortic Valve Endocarditis: Does Early Surgery Improve Risks or Prognosis? |
| title_full | The Dilemma of Surgical Timing in Acute Aortic Valve Endocarditis: Does Early Surgery Improve Risks or Prognosis? |
| title_fullStr | The Dilemma of Surgical Timing in Acute Aortic Valve Endocarditis: Does Early Surgery Improve Risks or Prognosis? |
| title_full_unstemmed | The Dilemma of Surgical Timing in Acute Aortic Valve Endocarditis: Does Early Surgery Improve Risks or Prognosis? |
| title_short | The Dilemma of Surgical Timing in Acute Aortic Valve Endocarditis: Does Early Surgery Improve Risks or Prognosis? |
| title_sort | dilemma of surgical timing in acute aortic valve endocarditis does early surgery improve risks or prognosis |
| topic | infective endocarditis aortic valve homograft early treatment timing antibiotics |
| url | https://www.mdpi.com/2308-3425/12/4/153 |
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