Reply to Tleyjeh and Baddour

Le résumé fourni par la source

We read with interest Drs Tleyjeh's and Baddour's comment on our recent paper [1, 2]. We acknowledge their concern regarding the nonsignificant higher adjusted risk of death among patients with early valve replacement during infective endocarditis (IE). As stated in the manuscript, the results should be interpreted cautiously given the limitations of the study and possible hidden confounders. The authors of the comment suggest that a propensity score analysis would better estimate the impact of early surgical intervention on the hospital mortality in patients with IE and stroke. However, we would argue that data such as those being analyzed in the present study could be equally well analyzed with a Cox proportional hazard regression model adjusted for survival prognostic factors, surgical mortality prognostic factors, and timing of surgery [3]. The authors of the comment also suggest examining the impact of early surgery in the entire cohort (medical and surgical) of IE patients with stroke. We appreciate this suggestion and will present our analysis at the 12th Interscience Conference on Cardiovascular and Infectious Diseases this year. In conclusion, according to our observational study, there was no clear finding that early surgery was associated with higher in-hospital mortality in IE. We agree that additional, larger studies are needed to better define the appropriate timing of surgery in IE with or without major complications such as stroke. Potential conflicts of interest. V. H. C. has received institutional grant support from the American Heart Association. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.