title: Early and late survival after surgical treatment of culture-positive active endocarditis.
abstract: OBJECTIVE
  To describe a 30-year experience with surgically treated culture-positive active endocarditis.
  
  
  METHODS
  We retrospectively reviewed the microbiologic, clinical, and operative findings and the survival data in 151 patients with culture-positive active endocarditis encountered between 1961 and 1991.
  
  
  RESULTS
  The mean age of the 110 male and 41 female patients was 49.8 years. Native valve endocarditis was present in 86 patients, and prosthetic valve endocarditis (PVE) was diagnosed in 65. The aortic valve was involved in 62% of patients, the mitral valve in 25%, and both valves in 10%. The operative mortality was 26%. The most important univariate determinants of mortality were an abscess at operation (P = 0.01) and renal failure (P = 0.03). A trend toward a higher mortality with PVE and staphylococcal infection was noted. For hospital survivors, the 5- and 10-year survival was 71% and 60%, respectively. Univariate determinants of an adverse long-term survival were annular abscess (P = 0.01), renal impairment (P = 0.01), heart failure (P = 0.02), and aortic valve involvement (P = 0.05). On multivariate analysis, the most important adverse determinants of long-term survival were heart failure (P = 0.02), renal impairment (P = 0.02), and PVE (P = 0.03). Thirty patients required a subsequent reoperation; of these, seven required a second and two a third operation. The most common reason for reoperation was periprosthetic regurgitation without infection (N = 19). Four operations were performed for recurrent endocarditis. At 5 and 10 years, the risk of reoperation was 23% and 36%, respectively.
  
  
  CONCLUSIONS
  Although surgical treatment of culture-positive active endocarditis is still associated with substantial mortality, the long-term outcome of hospital survivors is excellent. Subsequent reoperations for periprosthetic leak are common, but recurrent infection is uncommon.
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Mayo Clinic Rochester, MN 55905, USA.
authors.forename: C J
authors.initials: CJ
authors.lastname: Mullany
authors.forename: Y L
authors.initials: YL
authors.lastname: Chua
authors.forename: H V
authors.initials: HV
authors.lastname: Schaff
authors.forename: J M
authors.initials: JM
authors.lastname: Steckelberg
authors.forename: D M
authors.initials: DM
authors.lastname: Ilstrup
authors.forename: T A
authors.initials: TA
authors.lastname: Orszulak
authors.forename: G K
authors.initials: GK
authors.lastname: Danielson
authors.forename: F J
authors.initials: FJ
authors.lastname: Puga
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve; D001807:Blood Vessel Prosthesis / Q000009:adverse effects* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D001026:Coronary Artery Bypass / Q000401:mortality; D004697:Endocarditis, Bacterial / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve; D015999:Multivariate Analysis; D016459:Prosthesis-Related Infections / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000382:microbiology / Q000401:mortality / Q000601:surgery; D013290:Streptococcal Infections / Q000382:microbiology / Q000401:mortality / Q000601:surgery; D015996:Survival Rate; D013997:Time Factors; D014261:Tricuspid Valve