Results of surgical treatment for infective endocarditis in intravenous drug users.
OBJECTIVE
To determine the early and late results of surgical treatment for infective endocarditis (IE) in intravenous drug users (IVDU).


METHODS
Cohort study of consecutive IVDUs undergoing surgical treatment for IE.


METHODS
Large public hospital serving the urban population of Chicago, Ill.


METHODS
Consecutive IVDUs operated on between July 1982 and June 1991 for IE.


METHODS
Death, stroke, noncerebral systemic embolization, major bleeding, recurrent endocarditis, and repeated valve replacement.


RESULTS
There were 80 patients, 58 men and 22 women, with a mean age of 37.5 +/- 10 (SD) years. The hospital course in all patients and follow-up data on 75 (94%) patients were complete. The primary indication for surgery was acute congestive heart failure in 44 (56%), persistent sepsis in 21 (26%), and multiple systemic embolization in 15 (19%) patients. Six patients (7.5%) died within 30 days of surgery. An additional 13 of 69 patients (17.6%) died during the follow-up, 8 from cardiovascular causes. The probability of survival at 36 months and at 60 months was 0.74 +/- 0.05 (SE) and 0.70 +/- 0.05, respectively. Seventeen (30%) of the survivors had at least one major cardiovascular event; 6 (8.8%) had recurrent endocarditis, 4 (5.8%) had stroke, 3 (4.4%) had extracerebral bleeding, 1 had extracerebral systemic embolism, and 3 (4.4%) required repeated valve replacement. Probability of event-free survival at 36 months and 60 months was 0.65 +/- 0.06 and 0.52 +/- 0.08, respectively. The median duration of event-free survival was 65 months.


CONCLUSIONS
Since the expected mortality without surgery in patients with IE in whom medical treatment fails is almost 100%, it is concluded that surgical treatment is indicated for, and substantially improves the outlook for early and late survival of, IVDUs with IE who fail to respond to medical management.
Mathew
J
J
Department of Medicine, Cook County Hospital, Chicago, IL 60612, USA.
Abreo
G
G
Namburi
K
K
Narra
L
L
Franklin
C
C
D000328:Adult; D004697:Endocarditis, Bacterial / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D005260:Female; D006351:Heart Valves / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D012189:Retrospective Studies; D015819:Substance Abuse, Intravenous / Q000150:complications*; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome