PMID- 22382703
OWN - NLM
STAT- MEDLINE
DCOM- 20130510
LR  - 20211021
IS  - 1435-2451 (Electronic)
IS  - 1435-2443 (Linking)
VI  - 397
IP  - 8
DP  - 2012 Dec
TI  - Is simultaneous splenectomy an additive risk factor in surgical treatment for 
      active endocarditis?
PG  - 1261-6
LID - 10.1007/s00423-012-0931-y [doi]
AB  - PURPOSE: Splenic abscess formation is a serious complication in the setting of 
      active endocarditis, and splenectomy is recommended. However, the optimal timing 
      for splenectomy is yet undetermined. The purpose of this study was to evaluate 
      the role of a one-stage splenectomy and valve surgery for active endocarditis. 
      METHODS: Among 202 consecutive endocarditis patients, 18 had splenic lesions on 
      preoperative abdominal screening, who underwent cardiac surgery and splenectomy 
      as a one-stage procedure (group A) and were compared to patients with 
      unremarkable abdominal screening (group B, n = 184) undergoing sole cardiac 
      surgery. RESULTS: No difference was observed regarding preoperative 
      characteristics (age, gender, New York Heart Association [NYHA] grade, diabetes, 
      coronary artery disease, redo surgery, adiposity, smoking), intubation time, and 
      prolonged ventilation. There were 23 early postoperative deaths in group B 
      (12.5%) vs. none in group A. At 180 days, survival was significantly higher for 
      patients in group A (94.4%) vs. group B (67.9%, p = 0.016), although this 
      difference did not reach statistical significance (log-rank test, p = 0.073). 
      Multivariate Cox proportional hazards regression revealed age above 50 years 
      (hazard ratio [HR] 3.327, 95% confidence interval [CI] 1.279-8.650) and NYHA 
      class above III (NYHA III or IV: HR 3.117, 95% CI 1.119-8.683, p = 0.030; NYHA 
      IV: HR 3.678, 95% CI 1.984-6.817, p < 0.001) as independent risk factors for 
      mortality at 180 days. A trend towards a protective factor was observed for 
      simultaneous splenectomy (HR = 0.171, 95% CI 0.023-1.255). CONCLUSION: 
      Simultaneous valve surgery and splenectomy is an approach for active endocarditis 
      complicated by splenic lesions with a low 180-day mortality. Despite the expected 
      risk elevation by septic lesions and the additive trauma of a laparotomy, 
      patients with simultaneous splenectomy had a favourable outcome regarding early 
      mortality and mortality at 6 months.
FAU - Akhyari, Payam
AU  - Akhyari P
AD  - Department of Cardiac Surgery, University Hospital Heidelberg, INF 110, 69120, 
      Heidelberg, Germany. Payam.akhyari@med.uni-duesseldorf.de
FAU - Mehrabi, Arianeb
AU  - Mehrabi A
FAU - Adhiwana, Angelina
AU  - Adhiwana A
FAU - Kamiya, Hiroyuki
AU  - Kamiya H
FAU - Nimptsch, Katharina
AU  - Nimptsch K
FAU - Minol, Jan-Philipp
AU  - Minol JP
FAU - Tochtermann, Ursel
AU  - Tochtermann U
FAU - Godehardt, Erhrad
AU  - Godehardt E
FAU - Weitz, Jurgen
AU  - Weitz J
FAU - Lichtenberg, Artur
AU  - Lichtenberg A
FAU - Karck, Matthias
AU  - Karck M
FAU - Ruhparwar, Arjang
AU  - Ruhparwar A
LA  - eng
PT  - Journal Article
DEP - 20120301
PL  - Germany
TA  - Langenbecks Arch Surg
JT  - Langenbeck's archives of surgery
JID - 9808285
SB  - IM
MH  - Adult
MH  - Aged
MH  - *Cardiac Surgical Procedures
MH  - Endocarditis, Bacterial/complications/mortality/*surgery
MH  - Female
MH  - Heart Valve Prosthesis Implantation
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Risk Factors
MH  - Splenectomy/*adverse effects
MH  - Splenic Infarction/etiology/mortality/*surgery
MH  - Survival Rate
EDAT- 2012/03/03 06:00
MHDA- 2013/05/11 06:00
CRDT- 2012/03/03 06:00
PHST- 2011/11/22 00:00 [received]
PHST- 2012/02/14 00:00 [accepted]
PHST- 2012/03/03 06:00 [entrez]
PHST- 2012/03/03 06:00 [pubmed]
PHST- 2013/05/11 06:00 [medline]
AID - 10.1007/s00423-012-0931-y [doi]
PST - ppublish
SO  - Langenbecks Arch Surg. 2012 Dec;397(8):1261-6. doi: 10.1007/s00423-012-0931-y. 
      Epub 2012 Mar 1.