title: Surgical treatment of infective aortic valve endocarditis.
abstract: Fifty-eight adult patients treated with aortic valve replacement for infective endocarditis were retrospectively reviewed. The operation was performed during antibiotic therapy (group I, n = 25) or after completion of such therapy, on average 17 months after diagnosis (group II, n = 33). Preoperatively 68% of group I and 24% of group II were in NYHA class IV. Bacterial aetiology was verified in 78% of all cases. Preoperative embolic complications occurred in six group I and three group II cases, causing hemiplegia in eight. At operation the aortic valve was bicuspid in 29 of the 58 patients. Vegetations and cusp perforation were present in most cases. Bacteria were demonstrated in 11 of the excised specimens. A mechanical valve prosthesis was inserted in all cases. Three patients died, one perioperatively and two during their time in hospital (2 from group I). Low-output syndrome was the commonest postoperative complication. During follow-up averaging 66 months, 12 patients died (6 of cardiac causes). Late complications were periprosthetic leakage (2 cases), significant embolism (5), and prosthetic valve endocarditis (4), causing periprosthetic leakage in one case.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Helsinki University Central Hospital, Finland.
authors.forename: E
authors.initials: E
authors.lastname: Varstela
authors.forename: K
authors.initials: K
authors.lastname: Verkkala
authors.forename: S
authors.initials: S
authors.lastname: Pohjola-Sintonen
authors.forename: V
authors.initials: V
authors.lastname: Valtonen
authors.forename: T
authors.initials: T
authors.lastname: Maamies
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001021:Aortic Valve; D002303:Cardiac Output, Low / Q000453:epidemiology; D003131:Combined Modality Therapy; D004697:Endocarditis, Bacterial / Q000188:drug therapy / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents