title: [Early results of surgical treatment in acquired heart diseases during endocarditis in own material].
abstract: BACKGROUND
  Endocarditis can concern natural as well as artificial heart valves. In conservative treatment mortality reaches 24-60%. Surgical procedure is the only way to save these patients in most cases.
  
  
  METHODS
  Between 1998-2001, 114 patients underwent surgery because of valve endocarditis, 86 male and 28 female. 43 patients underwent mitral valve replacement (MVR), (13 MV reoperation), 51 aortic valve replacement (AVR), (16 AV reoperation) and 20 patients underwent MVR and AVR (3 both valves replacement). Three groups were similar regarding age, gender, emergency or elective procedures and NYHA class four. All patients underwent open heart surgery in ECC with hypothermia and crystalloid cardioplegia done by the same group of surgeons.
  
  
  RESULTS
  Operative mortality in the MVR group was 11.6% (five of 43) compared to 3.9% (two of 51) AVR patients and 25% (five of 20) MVR and AVR group. The highest mortality rate was in both infected artificial valves procedures. There was growth of the bacteria in intraoperative material in 37.6% (33) of cases, mainly Staphylococcus epidermidis and Staphylococcus aureus. Incidence of postoperative sepsis, multiorgan failure, high grade atrio-ventricular block or low cardiac output was the highest in MVR and AVR patients. Independent predictors of operative mortality included increasing patient age, female gender, infected valve reoperation, and history of stroke.
  
  
  CONCLUSIONS
  Our study suggests that patients with endocarditis and compromised hemodynamic status can be operated with acceptable morbidity and mortality. If echocardiography shows the cuspids perforations or vegetations, chords tendinous rupture or perivalvular leak, the patients should undergo cardiac surgery as soon as possible, in order to avoid severe embolic complications.
authors.affiliation: Klinika Chirurgii Serca, Naczyń i Transplantologii Collegium Medicum, Uniwersytetu Jagiellońskiego, Kraków.
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Samitowski
authors.forename: Dariusz
authors.initials: D
authors.lastname: Plicner
authors.forename: Rafał
authors.initials: R
authors.lastname: Drwiła
authors.forename: Edward
authors.initials: E
authors.lastname: Pietrzyk
authors.forename: Józef
authors.initials: J
authors.lastname: Kopacz
authors.forename: Bogusław
authors.initials: B
authors.lastname: Kapelak
authors.forename: Jerzy
authors.initials: J
authors.lastname: Sadowski
mesh_terms: D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000382:microbiology / Q000601:surgery; D004697:Endocarditis, Bacterial / Q000150:complications* / Q000401:mortality / Q000601:surgery*; D005260:Female; D006349:Heart Valve Diseases / Q000382:microbiology* / Q000401:mortality / Q000601:surgery*; D006350:Heart Valve Prosthesis / Q000382:microbiology; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000382:microbiology / Q000601:surgery; D012086:Reoperation; D013203:Staphylococcal Infections / Q000150:complications / Q000601:surgery; D016896:Treatment Outcome