Impact of early surgery in non-complicated left-sided native-valve infective endocarditis with large vegetations

Introduction The impact of early surgery for patients with left-sided native-valve infective endocarditis (LS-NV-IE) with a large vegetation (between 10 and 30 mm), free of embolic events and of other complication, has not yet been established. We aimed to describe the characteristics of these patients and to assess the impact of early surgery (≤ 7 days) in terms of 6-month outcomes. Method Among 1340 patients diagnosed with LS-NV-IE, 174 patients with a vegetation between 10 and 30 mm and without class I or IIa indication for surgery (according to European guidelines) were included. The primary endpoint combined death and endocarditis complications (recurrence of endocarditis, heart failure requiring hospitalization, or clinical embolic event) at 6-months Results Patients (n = 42) who underwent early surgery were younger (P = 0.019) and more likely to have a vegetation length > 15 mm (66.7%vs.47.7%) and highly mobile vegetations (59.5%vs.39.4%), than patients managed conservatively. The 6-month event-free survival was 98 ± 2% in the early surgery group and 86 ± 3% in the conservative group (P = 0.037), even after propensity matching (P = 0.003). On multivariable analysis, early surgery was associated with better outcome [Adjusted HR(95%CI) = 0.16(0.04–0.97); P = 0.046] ( Fig. 1 ). Conclusion Early surgery for patients with LS-NV-IE and vegetation between 10 and 30 mm, free of embolic events and of other IE complication, is associated with a lower rate of events at 6 months.