Purpose

Background: Prognosis of infective endocarditis is poor and has remained steady over the last four decades. Several nonrandomized studies suggest that early surgery could improve prognosis.

Methods: The early surgery in infective endocarditis study (ENDOVAL 1) is a multicenter, prospective, randomized study designed to compare the state-of-the-art therapeutic strategy (that advised by the international societies in their guidelines) with the early surgery strategy in high-risk patients with infective endocarditis. Patients with infective endocarditis without indication for surgery will be included if they meet at least one of the following: 1) early-onset prosthetic endocarditis; 2) Staphylococcus aureus endocarditis; 3) periannular complications; 4) new-onset conduction abnormalities; 5) vegetations longer than 10 mm in diameter; 6) new-onset severe valvular disfunction. A total of 216 patients will be randomized to either of the two strategies. Stratification will be done within 3 days of admission. In the early surgery arm, the procedure will be performed within 48 hours of randomization. The only event to be considered will be death within 30 days. The study will be extended to 1 year. In the follow-up substudy, death and a new episode of endocarditis will be regarded as events.

Conclusion: The early surgery in infective endocarditis study (ENDOVAL 1), the first randomized in endocarditis, will provide crucial information regarding the putative benefit of early surgery over the state-of-the-art therapeutic approach in high-risk patients with infective endocarditis.


Condition Intervention Phase
Infective Endocarditis
 Procedure: Cardiac surgery
Procedure: State-to-the-art treatment
 Phase IV

Genetics Home Reference related topics:   Heart Diseases   Vascular Diseases  

MedlinePlus related topics:   Endocarditis   Surgery  

U.S. FDA Resources

Study Type:   Interventional
Study Design:   Treatment, Randomized, Open Label, Parallel Assignment, Efficacy Study
Official Title:   Rationale, Design and Methods for the Early Surgery in Infective Endocarditis Study: a Multicenter, Prospective, Randomized Trial Comparing the State-of-the-Art Therapeutic Strategy Versus Early Surgery Strategy in Infective Endocarditis

Further study details as provided by Instituto de Ciencias del Corazon:

Primary Outcome Measures:
  • In-hospital mortality rate in high-risk patients with active infective endocarditis between an early surgical approach and the state-of-the-art treatment in this disease. [ Time Frame: In-hospital mortality ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • One year mortality rate in high-risk patients with active infective endocarditis between an early surgical approach and the state-of-the-art treatment in this disease. [ Time Frame: One year ] [ Designated as safety issue: No ]

Estimated Enrollment:   216
Study Start Date:   September 2007
Estimated Study Completion Date:   September 2010
Estimated Primary Completion Date:   November 2007 (Final data collection date for primary outcome measure)

Arms Assigned Interventions
1: Experimental
Early-surgery, within 48 hours from randomization
Procedure: Cardiac surgery
Cardiac surgery within 48 hours of randomization
2: Active Comparator
State-to-the-art group. Antibiotic treatment and surgery if emergency or sequelae of endocarditis as recommended in the guidelines
Procedure: State-to-the-art treatment
Antibiotic treatment and surgery if emergency or sequelae of endocarditis as recommended in the guidelines

 Show Detailed Description

  Eligibility
Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No

Criteria

Inclusion Criteria:

  • Patients older than 18 years.
  • Infective endocarditis diagnosed by modified Duke criteria.

  • At least one of the following risk factors:

    1. Periannular complications
    2. New onset auriculo-ventricular block
    3. New onset severe valvular insufficiency
    4. Early-onset prosthetic valve endocarditis
    5. Staphylococcus aureus endocarditis
    6. Vegetations greater than 20 mm

Exclusion Criteria:

  • Patients with urgent/emergent indication of surgery when endocarditis is diagnosed:

    1. Heart failure because of valvular insufficiency.
    2. Fungal endocarditis.
    3. Septic shock.
  • Patients referred from other centers to be operated on.
  • Patients without echocardiographic evidence of endocarditis.
  • Pregnant or lactating women.
  • Simultaneous participation in other research study.
  • Incapacity to mantein the conditions of the study.
  • Patients referred from other centers more than 5 days after the diagnosis of infective endocarditis.
  • Patients with prohibitive risk for surgery due to comorbidities, estimated by previous validated scales. An Euroescore value greater than 40% will be considered a contraindication to enter the protocol.
  • Patients with ischemic or haemorragic stroke within one month before the diagnosis of endocarditis.
  • Endocarditis in intravenous drug addicts patients.
  • Not signed the inform consent.
  Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT00624091

Contacts
Contact: Javier López, MD, PhD     0034 616 103161     javihouston@yahoo.es    
Contact: José A San Román, PhD, FESC     0034 983 42 00 14     asanroman@secardiologia.es    

Locations
Spain
Universitary Hospital of Valladolid     Recruiting
      Valladolid, Spain, 47003
      Contact: Pedro Mota, MD     0034 983 420014     motagomezp@hotmail.com    
      Sub-Investigator: Javier López, MD, PhD            

Sponsors and Collaborators
Instituto de Ciencias del Corazon

Investigators
Principal Investigator:     José A San Román, MD, FESC     Instituto de Ciencias del Corazon    
Contact: Javier López, MD, PhD     0034 616 103161     javihouston@yahoo.es    
Contact: José A San Román, PhD, FESC     0034 983 42 00 14     asanroman@secardiologia.es    
Spain
Universitary Hospital of Valladolid     Recruiting
      Valladolid, Spain, 47003
      Contact: Pedro Mota, MD     0034 983 420014     motagomezp@hotmail.com    
      Sub-Investigator: Javier López, MD, PhD            
Instituto de Ciencias del Corazon
Principal Investigator:     José A San Román, MD, FESC     Instituto de Ciencias del Corazon    
  More Information

Responsible Party:   ICICOR ( Jose Alberto San Román Calvar )
Study ID Numbers:   ENDOVAL-1
First Received:   February 2, 2008
Last Updated:   February 18, 2008
ClinicalTrials.gov Identifier:   NCT00624091
Health Authority:   Spain: Comité Ético de Investigación Clínica

Keywords provided by Instituto de Ciencias del Corazon:
Early-surgery, infective endocarditis, in-hospital mortality  

Study placed in the following topic categories:
Bacterial Infections
Mycoses
Heart Diseases
Endocarditis, Bacterial
Endocarditis, infective
Infective endocarditis
Bacterial endocarditis
Endocarditis

Additional relevant MeSH terms:
Bacterial Infections and Mycoses
Cardiovascular Diseases
Cardiovascular Infections
Infection
Endocarditis, Bacterial

Source: National Library of Medicine (NLM) June 26, 2008

  


 
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