Long-term results and determinants of mortality after surgery for native and prosthetic valve endocarditis.
OBJECTIVE
The study aim was to describe the long-term results and determinants of mortality after operative treatment of native and prosthetic valve endocarditis at a single institution.


METHODS
Between March 1985 and October 1999, 171 patients underwent surgery for native (NVE) or prosthetic valve endocarditis (PVE). NVE was present in 98 patients (57%), and PVE in 73 patients (43%). Mean follow up was 5.6+/-3.9 years (range: 0 to 15 years).


RESULTS
Overall hospital mortality was 9.9% (n = 17). Hospital mortality was higher among patients with PVE (15.1%) than those with NVE (6.1%; p = 0.05). Overall survival at 10 years was 46+/-5%. Patients with NVE had a higher 10-year survival rate (53+/-7%) than those with PVE (37+/-7%; p = 0.02). At 10 years, overall freedom from any late complication was 47+/-6% and from residual or recurrent endocarditis was 78+/-5%. Predictors of hospital death were emergency surgery (p <0.003) and preoperative renal insufficiency (p <0.008). Predictors of late death were age >70 years (p <0.002), renal failure (p <0.03) and fungal endocarditis (p <0.04).


CONCLUSIONS
These findings demonstrate the increased perioperative, as well as postoperative, risks associated with PVE versus NVE. Cardiac and extracardiac manifestations of the disease, as well as fungal organisms, but not the activity of the endocarditis, were significant adverse determinants of late outcome.
Grünenfelder
J
J
Cardiac Surgical Unit, Massachusetts General Hospital, Harvard Medical School, Boston 02114, USA.
Akins
C W
CW
Hilgenberg
A D
AD
Vlahakes
G J
GJ
Torchiana
D F
DF
Madsen
J C
JC
MacGillivray
T E
TE
D004696:Endocarditis / Q000209:etiology / Q000401:mortality* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000209:etiology / Q000401:mortality* / Q000601:surgery*; D006350:Heart Valve Prosthesis / Q000009:adverse effects* / Q000382:microbiology; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors