title: Surgical therapy in patients with active infective endocarditis: seven-year single centre experience in a subgroup of 255 patients treated with the Shelhigh stentless bioprosthesis.
abstract: OBJECTIVE
  We investigated outcomes after surgical therapy in patients with active infective endocarditis (AIE) with regard to survival in relation to surgical urgency, valve position, number of valves implanted and abscess formation. We aimed to identify independent risk factors for early mortality.
  
  
  RESULTS
  Two hundred and fifty-five patients received Shelhigh bioprostheses between February 2000 and March 2007. A total of 74.1% had native and 25.9% prosthetic AIE. Surgery was regarded as urgent in 57.3% and as an emergency procedure in 38.4%. There was a highly significant difference in survival rate between patients who were operated on urgently versus in an emergency (p<0.0001), between single and double valve replacement (p=0.0206) and between patients with and without abscess formation (p=0.0245). There were two cases of early reinfection (0.78%) and six of late reinfection (2.35%) leading to re-operation.
  
  
  CONCLUSIONS
  The survival of patients differs significantly in dependence on their surgical urgency. Better outcome could have been achieved if patients had been referred earlier for surgery and operated upon before heart failure or septic shock developed. Long-term survival was better in patients without abscess formation. The low reinfection rate of Shelhigh bioprostheses in AIE is promising and the early and mid-term results achieved need to be verified in the long-term course.
authors.affiliation: Deutsches Herzzentrum Berlin, Department of Cardiothoracic and Vascular Surgery, Augustenburger Platz 1, Berlin, Germany. musci@dhzb.de
authors.forename: Michele
authors.initials: M
authors.lastname: Musci
authors.forename: Henryk
authors.initials: H
authors.lastname: Siniawski
authors.forename: Miralem
authors.initials: M
authors.lastname: Pasic
authors.forename: Yuguo
authors.initials: Y
authors.lastname: Weng
authors.forename: Antonio
authors.initials: A
authors.lastname: Loforte
authors.forename: Susanne
authors.initials: S
authors.lastname: Kosky
authors.forename: Charles
authors.initials: C
authors.lastname: Yankah
authors.forename: Roland
authors.initials: R
authors.lastname: Hetzer
mesh_terms: D000038:Abscess / Q000209:etiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery; D001705:Bioprosthesis; D004630:Emergencies; D004697:Endocarditis, Bacterial / Q000601:surgery*; D004812:Epidemiologic Methods; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery; D016459:Prosthesis-Related Infections / Q000209:etiology; D012008:Recurrence; D016896:Treatment Outcome