title: Surgical treatment of active infective endocarditis: a continued challenge.
abstract: OBJECTIVE
  This study was undertaken to examine the outcomes of surgery for active infective endocarditis in a large cohort of patients.
  
  
  METHODS
  Three hundred eighty-three consecutive patients underwent surgery for active infective endocarditis. The mean age was 51 +/- 16 years, and 64% were men. The infected valve was native in 266 patients and prosthetic in 117. Staphylococcus aureus was the most common microorganism. Surgery consisted of valve replacement or repair in patients with infection limited to the cusps or leaflets of the valve or radical resection of seemingly infected paravalvular tissues, and reconstruction with patches and valve replacement in patients with abscess (135 patients). The mean follow-up was 6.1 +/- 5.2 years.
  
  
  RESULTS
  There were 45 (12%) operative and 88 (23%) late deaths. The operative mortality did not change during the period of study. Preoperative shock, prosthetic valve endocarditis, paravalvular abscess, and S aureus were independent predictors of operative mortality. Age, shock, prosthetic valve endocarditis, left ventricular ejection fraction less than 40%, and recurrent endocarditis were independent predictors of death from all causes. Survivals at 15 years were 44% +/- 5% overall, 59% +/- 5% for native valve endocarditis, and 25% +/- 7% for prosthetic valve endocarditis (P = .001). Freedom from recurrent endocarditis at 15 years was 86% +/- 3% for all patients, similar to those for native and prosthetic valve endocarditis (P = .39). Freedom from reoperation at 15 years was 70% +/- 6% for all patients, similar to those for native and prosthetic valve endocarditis (P = .55).
  
  
  CONCLUSIONS
  Surgery for endocarditis continues to be challenging and associated with high operative mortality and morbidity. Age, shock, prosthetic valve endocarditis, impaired ventricular function, and recurrent infections adversely affect long-term survival.
authors.affiliation: Division of Cardiovascular Surgery of Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada. tirone.david@uhn.on.ca
authors.forename: Tirone E
authors.initials: TE
authors.lastname: David
authors.forename: Gheorghe
authors.initials: G
authors.lastname: Gavra
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Feindel
authors.forename: Tommaso
authors.initials: T
authors.lastname: Regesta
authors.forename: Susan
authors.initials: S
authors.lastname: Armstrong
authors.forename: Manjula D
authors.initials: MD
authors.lastname: Maganti
mesh_terms: D006348:Cardiac Surgical Procedures / Q000401:mortality; D004697:Endocarditis, Bacterial / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects; D006351:Heart Valves / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000601:surgery; D012008:Recurrence; D013203:Staphylococcal Infections / Q000601:surgery; D015996:Survival Rate