Early extraction versus conservative management in patients with noninfected cardiac implantable electronic devices undergoing cardiac surgery for left-sided infective endocarditis: Insights from the multicentric Clinical Multicenter Project for Analysis of Infective Endocarditis in Germany Registry.

Abstract

This study aimed to analyze the outcomes of patients with left-sided infective endocarditis (IE) and noninfected cardiac implantable electronic device (CIED) undergoing cardiac surgery, with a focus on whether the CIED was removed. Retrospective analysis based on the Clinical Multicenter Project for Analysis of Infective Endocarditis in Germany Registry, comprising patients with left-sided IE who underwent valve surgery between 1994 and 2018 in 6 German centers. Two treatment strategies were compared: CIED extraction versus no extraction. The primary outcomes were 30-day mortality, long-term survival, and recurrent IE rates. Propensity score matching was performed to account for baseline differences. From a total of 4917 registry patients, 245 met the inclusion criteria. The CIED was not extracted in 145 (59.1%) patients and extracted in 100 (40.8%) patients, with propensity score matching resulting in 74 similar pairs. The 30-day mortality was 13.5% versus 20.3% in the extraction and nonextraction groups, respectively (P = .23). Intensive care unit (median, 4 vs 8 days; P = .003) and hospital stays (median, 17 vs 24 days; P < .001) were significantly longer in the extraction group. The estimated 8-year survival was 31.5% versus 28.6% in the extraction and nonextraction groups, respectively (subdistribution hazard ratio, 0.8; 95% CI, 0.5-1.2; P = .26). The estimated recurrent IE rate at 6 months was 3.5% versus 4.7%, and at 8 years, 5.4% versus 11.3%, in the extraction and nonextraction groups, respectively (subdistribution hazard ratio, 0.43; 95% CI, 0.1-1.7; P = .24). In patients with left-sided IE and noninfected CIED undergoing cardiac surgery, CIED extraction was not associated with a survival advantage or lower recurrent IE rates, but with longer intensive care unit and hospital stays.