Impact of valve surgery on 6-month mortality in adults with complicated, left-sided native XXXX : a propensity analysis.

@entity1 @entity281 @entity340 @entity712
CONTEXT: Complicated, left-sided native @entity340 causes significant morbidity and mortality in adults. The presumed benefits of valve surgery remain unproven due to lack of randomized controlled trials. OBJECTIVE: To determine whether valve surgery is associated with reduced mortality in adults with complicated, left-sided native @entity340 . DESIGN AND SETTING: Retrospective, observational cohort study conducted from January 1990 to January 2000 at 7 Connecticut hospitals. Propensity analyses were used to control for bias in treatment assignment and prognostic imbalances. @entity1 : Of the 513 adults with complicated, left-sided native @entity340 , 230 (45%) underwent valve surgery and 283 (55%) received medical therapy alone. MAIN OUTCOME MEASURE: All-cause mortality at 6 months after baseline. RESULTS: In the 6-month period after baseline, 131 @entity1 (26%) died. In unadjusted analyses, valve surgery was associated with reduced mortality (16% vs 33%; hazard ratio [HR], 0.43; 95% confidence interval [CI], 0.29-0.63; P<.001). After adjustment for baseline variables associated with mortality (including hospital site, comorbidity, @entity712 , microbial etiology, immunocompromised state, abnormal mental status, and @entity281 ), valve surgery remained associated with reduced mortality (adjusted HR, 0.35; 95% CI, 0.23-0.54; P<.02). In further analyses of 218 @entity1 matched by propensity scores, valve surgery remained associated with reduced mortality (15% vs 28%; HR, 0.45; 95% CI, 0.23-0.86; P =.01). After additional adjustment for variables that contribute to heterogeneity and confounding within the propensity-matched group, surgical therapy remained significantly associated with a lower mortality (HR, 0.40; 95% CI, 0.18-0.91; P =.03). In this propensity-matched group, @entity1 with moderate to severe @entity712 showed the greatest reduction in mortality with valve surgery (14% vs 51%; HR, 0.22; 95% CI, 0.09-0.53; P =.001). CONCLUSIONS: Valve surgery for @entity1 with complicated, left-sided native @entity340 was independently associated with reduced 6-month mortality after adjustment for both baseline variables associated with the propensity to undergo valve surgery and baseline variables associated with mortality. The reduced mortality was particularly evident among @entity1 with moderate to severe @entity712 .
