Medical Versus Surgical Management of Infective Endocarditis in a Western Australia Tertiary Hospital Setting

Abstracts

682 Mechanisms of Sex-difference in Serotonergic and ␣1 -adrenergic Vasoconstriction in the Internal Mammary Artery of Patients Going Through Coronary Artery Bypass Graft V. Lamin 1,∗ , A. Jaghoori 1 , M. Worthington 2 , J. Edwards 2 , F. Viana 2 , R. Stuklis 2 , D. Wilson 1 , J. Beltrame 1 1 School

of Medicine, University of Adelaide and Cardiology Research Unit, Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Adelaide, Australia 2 D’Arcy Sutherland Cardiothoracic Surgical Unit, Royal Adelaide Hospital, Adelaide, Australia Background: Females have poorer outcomes following coronary bypass surgery (CABG) than males and sex-differences in the internal mammary artery (IMA) vasoconstrictor properties have been proposed to contribute to this differential outcome. The objective of this study was to determine the role of: (1) endothelial integrity, (2) nitric oxide (NO) and (3) prostaglandins (PG) in mediating sexdifferences in IMA vasoconstriction to serotonin (5HT) and ␣1 -adrenergic agonist phenylephrine (PE). Methods: Contractile responses of male (n=60) and female (n=50) IMA to 5HT or PE were generated in the presence or absence of an intact endothelium. Nitric oxide synthase (NOS) and cyclooxygenase (COX) inhibitors were used to evaluate the role of NO and PG in mediating the sexdependent vasoconstriction in the presence of 5HT or PE. Electron paramagnetic resonance (EPR) was used to quantify NO release in response to the endothelium-dependent vasodilator (A23187). Results: Female IMA’s had increased sensitivity to 5HT and PE than males. (1) Endothelial denudation abolished this sex-difference for both 5HT and PE, implicating the involvement of an endothelial factor. (2) NO did not contribute to the sex-difference for either agonist since EPR-assessed NO production did not differ or NOS inhibition have no impact. (3) However, COX inhibition abolished female IMA hypersensitivity to 5HT and PE. Conclusions: These data indicate that the female IMA hypersensitivity to the 5HT and PE are mediated via an endothelium-dependent COX pathway. Ongoing studies are investigating the potential autocoids involved. Therapies targeting this pathway may negate the sex-difference and improve outcomes amongst women undergoing CABG. http://dx.doi.org/10.1016/j.hlc.2016.06.684 683 Medical Versus Surgical Management of Infective Endocarditis in a Western Australia Tertiary Hospital Setting N. Lan ∗ , C. Judkins Fiona Stanley Hospital, Perth, Australia

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Background: Infective endocarditis (IE) has high inhospital mortality. Well-defined guidelines assist in decision making around medical vs surgical management. We describe in-hospital mortality of IE in 3 tertiary hospitals comparing medical vs surgical management. Methods: Retrospective analysis of IE management during realignment of cardiothoracic surgery services was performed. Between 01/04/14 and 01/10/14, IE cases at 2 hospital sites were identified and following transfer of those services to a new hospital site, IE cases between 01/04/15 and 01/10/15 were identified. 56 patients were included (15 at each site pre-alignment and 26 post-alignment). Indications for surgery were based on the American Heart Association/American College of Cardiology guidelines. Results: Overall IE mortality was high with 12.5% inhospital death. 21/38 patients meeting surgical criteria underwent operative management, however, the threshold for surgery differed between hospital sites. Those patients meeting surgical criteria had non-significantly higher mortality (18.4% vs 0%, p=0.084). Patients meeting surgical criteria who got surgery versus those who did not get surgery had lower in-hospital mortality (4.8% vs 35.3%, p=0.031). Overall in-hospital mortality was non-significantly lower in the group that received surgery (4.8% vs 17.1%, p=0.237). In-hospital mortality was lower at sites with higher rates of surgical intervention that followed guidelines. Conclusions: We describe variation in surgical intervention and improved in-hospital mortality outcomes when adherence to indication for surgery guidelines are followed. We recommend cardiology units review their surgical utilisation to optimise IE outcomes. http://dx.doi.org/10.1016/j.hlc.2016.06.685 684 Meta-Analysis of Early or Late Surgery for Infective Endocarditis and Associated Stroke T. Wang 1,∗ , M. Wang 2 , J. Pemberton 1 1 Green

Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand 2 Department of Medicine, University of Auckland, Auckland, New Zealand Background: Surgery is recommended for infective endocarditis patients who develop ischaemic stroke, however the optimal timing of surgery remains controversial. In this metaanalysis, we compared the outcomes of early and delayed cardiac surgery for infective endocarditis in this setting. Methods: PubMed, MEDLINE, Embase, Cochrane and Scopus databases from 1 January 1980 to 30 June 2015 were searched for original studies. Two authors evaluated these studies for inclusion independently, then extracted and pooled data for analyses. Results: Amongst 2,423 papers obtained from the search, 23 full-texts were reviewed, and six studies involving 701 patients were included for analyses. Early surgery was defined as less than 7 days from diagnosis in 2 studies and less than 14 days in 4 studies. Rates and pooled odds ratio (95% confidence interval) for operative mortality of early or