title: Long-term outcomes in valve replacement surgery for infective endocarditis.
abstract: BACKGROUND
  Infective endocarditis is associated with a high rate of long-term mortality. Patients with a history of intravenous drug use (IVDU) are at increased risk for infective endocarditis. However, few studies have reported results of surgical treatment on this population. We present 19.5 years of experience with surgically treated patients with infective endocarditis.
  
  
  METHODS
  A retrospective study of all cardiac surgeries with a diagnosis of infective endocarditis at a single institution from 1986 to 2005 was performed. Logistic stepwise regression with an end point of operative mortality was done. Variables were age, gender, race, history of drug use, previous valve surgery, and previous valve replacement. Perioperative and outcome variables were compared between IVDU and non-IVDU populations.
  
  
  RESULTS
  The IVDU population required surgery at a younger age (39 +/- 9 years versus 54 +/- 15 years; p < 0.001). Overall operative mortality was 12% (41/346). The perioperative complication rate was similar for both groups. When adjusted for age, the two groups had similar long-term survival (p = 0.78). Kaplan-Meier estimator showed that survival at 10 and 15 years was 66% and 54% for IVDU and 56% and 42% for non-IVDU (number at risk, 19, 11, and 61, 28, respectively; p = 0.137). Reoperation for recurrent infective endocarditis was necessary in 9 (17%) of 52 of the IVDU group versus 14 (5%) of 270 of the non-IVDU group (p = 0.03).
  
  
  CONCLUSIONS
  Patients with a history of IVDU required reoperation for recurrent infective endocarditis at a significantly higher rate than the non-IVDU patients. Long-term survival was similar between the younger IVDU population and the older non-IVDU population. Anticipated life span is one of many factors when considering prosthetic valve choice in this population.
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine/Barnes Jewish Hospital, St. Louis, Missouri 63110, USA.
authors.forename: Scott P
authors.initials: SP
authors.lastname: Kaiser
authors.forename: Spencer J
authors.initials: SJ
authors.lastname: Melby
authors.forename: Andreas
authors.initials: A
authors.lastname: Zierer
authors.forename: Richard B
authors.initials: RB
authors.lastname: Schuessler
authors.forename: Marc R
authors.initials: MR
authors.lastname: Moon
authors.forename: Nader
authors.initials: N
authors.lastname: Moazami
authors.forename: Michael K
authors.initials: MK
authors.lastname: Pasque
authors.forename: Charles
authors.initials: C
authors.lastname: Huddleston
authors.forename: Ralph J
authors.initials: RJ
authors.lastname: Damiano
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Lawton
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001705:Bioprosthesis; D004697:Endocarditis, Bacterial / Q000401:mortality / Q000601:surgery*; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D015819:Substance Abuse, Intravenous / Q000150:complications*
chemical_list: D000900:Anti-Bacterial Agents