title: [Emergency valvular replacement in infective endocarditis: hospital and long term clinical course. Analysis of 45 patients].
abstract: BACKGROUND
  To define the evolution of patients with infective endocarditis who require urgent valve replacement in our environment.
  
  
  METHODS
  We followed 45 consecutive cases of infective endocarditis that require valve replacement during their hospitalization. 32 patients had native valve infective endocarditis, 7 early prosthesis valve endocarditis and 6 late prosthesis valve endocarditis. Patients were followed for a long-term period, clinical and echocardiographycally.
  
  
  RESULTS
  In 39 cases valve replacement was performed before ending antibiotic therapy. The main indications for surgery were refractory heart failure (24 patients) and shock (11 patients). The mortality rate was 24%: 19% in native valve infective endocarditis, 43% in early prosthetic valve endocarditis and 33% in late prosthesis valve endocarditis. The first cause of death was septic shock (46%). We followed 31 over 34 survivors for a mean time 65 (DS 49) months. We found two relapses and six deaths (1 sudden death, 2 endocarditis) and 72% of patients presented class I NYHA. We detected 17% prosthetic leaks (34% in the prosthetic valve endocarditis group).
  
  
  CONCLUSIONS
  The need of urgent valve replacement in the context of infective endocarditis is associated with a high mortality rate, and should be considered a serious condition. Long term prognosis is, however, acceptable, although 17% of patients had prosthesis leak, specially those with prosthetic valve endocarditis.
authors.affiliation: Departament de Cardiologia i Cirurgia Cardiaca, Hospital de la Santa Creu i Sant Pau, Barcelona.
authors.forename: J M
authors.initials: JM
authors.lastname: Alegret
authors.forename: X
authors.initials: X
authors.lastname: Borràs
authors.forename: C
authors.initials: C
authors.lastname: Alonso
authors.forename: F
authors.initials: F
authors.lastname: Carreras
authors.forename: M
authors.initials: M
authors.lastname: Gurguí
authors.forename: M L
authors.initials: ML
authors.lastname: Cámara
authors.forename: B
authors.initials: B
authors.lastname: Coll
authors.forename: G
authors.initials: G
authors.lastname: Pons-Lladó
mesh_terms: D004630:Emergencies; D004697:Endocarditis, Bacterial / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D016459:Prosthesis-Related Infections / Q000601:surgery*; D013997:Time Factors