Lyn, there's some vagueness in the language of the article, but I think my inference is reasonable. Here's some of the language:
And in the later passage where they talk about their "aggressive approach in the treatment of prosthetic valve endocarditis": The footnote refers to a 2007 article by David TE et al in Thorac Cardiocvasc Surg called "Surgical treatment of active infective endocarditis: a continued challenge".
Like you, I wondered how wise it would be to operate on somebody who still has active infective endocarditis; it sounds messy and dangerous. But it seems that they're doing exactly that, and getting much better survival results than from weeks of IV antibiotics, hence the "aggressive approach in the treatment of prosthetic valve endocarditis". I don't know if they still wait for (say) ONE week of IV antibiotics before they operate, but it sounds like they don't wait long, or as long as they used to, or as long as most other hospitals do. (The 2007 article may answer all these questions.)
Another interesting variable is WHERE the endocarditis patients in the cohort were treated. It sounds as if all the reops (including some of the mortalities) came back to UHN, and at least some or many of the non-ops went to other hospitals. That may or may not be important, but it's certainly not the same kind of "controlled" "one-center" study as the initial HVR.
I'm glad I asked, I thought maybe since you've said a few times now that they dont start with antibiotics, but go right to surgery-that maybe you had talked to your doctors since your earlier posts so knew that for a fact, and were just quoting the study more or less as an example. If you had talked to the doctors and were told that, it would have helped, but I think knowing it is just your thoughts or opinion from reading that study, that they don't start with weeks of antibiotics, and only operate,( immeadiately or after antibiotics,) on patients that meet certain criteria like CCF listed, but instead go right to surgery.
The reason I'm asking is I'm sure people who have to make decisions on their treament IF they are diagnosed with BE (or IE), weigh things they've read here with what their doctors reccomend, just like every other decisions about surgery, valve choice etc, so if Toronto does things differently than most of the other centers and guidelines, AND are having better results that would be good to know when weighing options, but if their "aggressive treatment" pretty much is the same as other large centers that basically follow the criteria regarding IF/when to operate, how aggressive to be when decidng how much tissue to remove during surgery, which meds for how long etc, depending on which bacteria, valve, comorbities like the CCF link above, that MIGHT make decisons a little easier or at least get rid of some of their doubts about what to agree to.
Yes I read that study, as you said it is vague about the treatment for the patients with BE, which makes sense since it is about the valve and that group of patients outcomes and not BE treatment, so for this study the important part is the number of patient w/ BE and the different outcomes and any other causes of complications or deaths.
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It's funny how different people can take different ideas away from reading the same thing, and I might be completely wrong, but In My opinion the word "alone", is important in this sentence "Survival was poor if patients were treated with antibiotics alone." and it doesn't say WHEN the 16 patients had their surgery, so I don't know that I personally would assume it was soon after diagnosises or when the infection was still active, especially since the results were so good,- even compared to the stats for their paper on surgery with ACTIVE infection, that you had quoted before
http://www.valvereplacement.org/for...-in-three-years-age-64&highlight=endocarditis and wonderred why the survival stats were worse in the 07 paper.
I still haven't read the entire 07 study, I'll try to later, hopefully it will answers some of the questions
