Comparative study on the impact of different surgical timing on clinical outcomes in patients with infective endocarditis and 5-10 mm vegetations
CHENG Shao-peng
WANG Yi-lin
LIU Chen
YANG Zhi-hao
JIANG Yi
LI Kai
WU Xiao-ting
WANG Dong-jin
YANG Jie
XUE Yun-xing
Abstract：Objective To assess whether emergency surgical intervention reduces adverse clinical events in patients with infective endocarditis(IE)presenting with vegetation diameters of between 5 and 10 mm.Methods A retrospective analysis was conducted involving 268 patients diagnosed with IE and vegetation sizes ranging from 5 to 10 mm who were admitted to Nanjing Drum Tower Hospital,Affiliated Hospital of Medical School,Nanjing University,between January 1,2019,and December 31,2024.Patients were stratified into an emergency surgery group,defined as those undergoing surgery,and a non-emergency surgery group.The primary endpoint was a composite outcome comprising all-cause mortality and postoperative new-onset embolic events.Results A total of 213 patients with IE who underwent surgical treatment were included in the analysis.Among these,92 patients(43.19%)received emergency surgery,while 121 patients(56.81%)underwent non-emergency surgery.Composite endpoint events occurred in 39 patients(18.31%),including 15 deaths(7.04%)and 24 postoperative new-onset embolic events(11.27%).Although the incidence of composite endpoint events and postoperative embolism was lower in the emergency surgery group compared with the non-emergency group[19 patients(20.65%)vs.20 patients(16.53%),P=0.44;11 patients(11.96%)vs.13 patients(10.74%),P=0.78,respectively],these differences did not reach statistical significance.All-cause mortality was marginally higher in the emergency surgery group,but this difference was also not statistically significant[8 patients(8.70%)vs.7 patients(5.79%),P=0.41].Multivariate Cox proportional hazards regression analysis identified advanced age(P=0.03,HR=1.31,95%CI 1.04-3.03),diabetes mellitus(P=0.04,HR=1.70,95%CI 1.02-2.83),staphylococcus aureus infection(P=0.03,HR=1.80,95%CI 1.06-3.54),prolonged duration of mechanical ventilation(P<0.01,HR=2.10,95%CI 1.55-2.85),and extended intensive care unit(ICU)stay(P=0.01,HR=1.43,95%CI 1.20-1.63)as independent predictors of adverse endpoint events.Conclusion Emergency surgical intervention did not confer a significant benefit in reducing all-cause mortality or postoperative mew-onset embolic event among IE patients with vegetation diameters of 5-10 mm.Independent factors associated with an increased risk of adverse outcomes included advanced age,diabetes mellitus,Staphylococcus aureus infection,prolonged mechanical ventilation,and extended ICU stay.
Keywords：Infective endocarditisVegetationsSurgical timingBacterial infectionComorbiditiesPrognosis
Publication Date：2026-01-25
Online Publishing Date：2026-02-04(First online date of this platform, not the publication date of the document)
Pages：6( 10-15 )