Surgical Data
Surgical treatment was indicated in 82 patients (49.1%) (Figure 1). The most frequent reasons were: decompensated heart failure (n=32, 39%), prevention of embolism (n=24, 29%), uncontrolled infection (n=9, 11%), recurrent emboli despite appropriate antibiotic treatment (n=5, 6.1%). Figure 1 shows the proportion of clinical versus surgical management across the 6 years of study recruitment.
Male sex (OR 3.3, 95% CI 1.3-8.1), chronic kidney disease (OR 3.2, 95% CI 1.2-8.5), valve regurgitation grade ≥ 3+ (OR 6.1, 95% CI 2.5-14.6) and the presence of abscess on echocardiogram (OR 5.7, 95% CI 1.1-31) were the independent predictors of need for surgery. Age was the only variable negatively associated with surgical indication (OR 0.97, 95% CI 0.94-0.99) (Table 5).
In the subgroup of patients who underwent a surgical intervention, the average time between definitive diagnosis and procedure was 9 (Q1-Q3 4-19) days. Procedural cardiopulmonary bypass and aortic cross-clamp median times were 82 (Q1-Q3 58-110) and 62 (Q1-Q3 44-83) minutes, respectively.