Active infective endocarditis: management and risk analysis of hospital death from 24 years' experience.
BACKGROUND
This study was performed to identify risk factors for hospital death in patients with acute and active infective endocarditis (AAIE) after surgical intervention.


RESULTS
From 1980 to 2004, 94 patients underwent surgery for AAIE (age range, 3-77 years; 76% males). Congestive heart failure (CHF) was present in 44 patients, as well as vegetations in 64, septicemia in 16, abscesses in 17, and emboli in 22; 16 patients had prosthetic valve endocarditis. Streptococci were the most common bacteria (34 patients), followed by staphylococci (17 patients). Mechanical valves were selected for 73 patients and bioprosthetic valves for 16. Mitral valve plasty was performed in 4 patients. Aortic root or aorto-mitral discontinuity was repaired in 17 patients, including Manouguian's double valve replacement in 6 and aortic root replacement in 4. Overall hospital mortality was 15% (14 patients). Univariate analysis identified CHF (p=0.016), abscess (p=0.014), and prosthetic valve endocarditis (p=0.043) as risk factors. However, multivariate analysis only identified CHF (p=0.019) as an independent risk factor.


CONCLUSIONS
In AAIE, early surgical intervention is advisable before the occurrence of complications such as root abscess and CHF, particularly before the onset of CHF.
Hanai
Makoto
M
Department of Cardiovascular Surgery, Jikei University School of Medicine, Tokyo, Japan.
Hashimoto
Kazuhiro
K
Mashiko
Kenoh
K
Sasaki
Tatsuumi
T
Sakamoto
Yoshimasa
Y
Shiratori
Kazuaki
K
Tanaka
Kei
K
Yoshitake
Michio
M
Naganuma
Hirokuni
H
Shinohara
Gen
G
D000038:Abscess / Q000382:microbiology / Q000401:mortality / Q000601:surgery; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000785:Aneurysm, Infected / Q000382:microbiology / Q000401:mortality / Q000601:surgery; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality*; D002648:Child; D002675:Child, Preschool; D003646:Debridement / Q000401:mortality; D004697:Endocarditis, Bacterial / Q000150:complications / Q000382:microbiology / Q000401:mortality* / Q000601:surgery*; D005260:Female; D006333:Heart Failure / Q000382:microbiology / Q000401:mortality / Q000601:surgery; D006349:Heart Valve Diseases / Q000150:complications / Q000382:microbiology / Q000401:mortality* / Q000601:surgery*; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000150:complications / Q000382:microbiology / Q000401:mortality* / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D000900:Anti-Bacterial Agents