title: Surgical treatment of multivalvular endocarditis: twenty-one-year single center experience.
abstract: OBJECTIVE
  Little information is available about surgical outcomes in patients with multivalvular endocarditis. The aim of this article is to review the 21-year experience with surgical treatment of patients with multivalvular endocarditis at our institution and, in particular, to determine the incidence, pathologic status, diagnosis, surgical strategies, and outcomes of patients with this disease.
  
  
  METHODS
  From January 1986 to December 2006, a total of 48 patients (40 men, 8 women), with a mean age of 42 +/- 12 years, underwent surgery for multivalvular endocarditis. Endocarditis was active in 32 patients and healed in 16. Preoperative transthoracic echocardiographic evaluation was performed in all 48 patients with addition of transesophageal echocardiography in 22 (45.8%). Intraoperative findings showed that the endocarditis involved mostly the mitral and aortic valves (40/48 patients). Triple or quadruple valve involvement was found in 1 and 2 patients, respectively. Preoperative, perioperative, and postoperative data were retrospectively analyzed and risk factors for early and late survival were determined.
  
  
  RESULTS
  In only 24 (50.0%) patients was multivalvular endocarditis diagnosed by preoperative transthoracic echocardiography; 17 (77.3%) patients had multivalvular endocarditis confirmed by preoperative transesophageal echocardiography. The 30-day hospital mortality was 12.5% (n = 6). Preoperative renal failure, New York Heart Association class IV, and emergency surgery were identified as independent risk factors for hospital mortality. Overall long-term survival was 74% +/- 6% at 5 years and 62% +/- 3% at 10 years. Multivariate analysis revealed that renal failure and recurrent endocarditis were associated with increased late mortality. Ten-year freedom from recurrent endocarditis was 74% +/- 5% and 10-year freedom from reoperation was 73% +/- 6%.
  
  
  CONCLUSIONS
  In our institution, multivalvular endocarditis was diagnosed by transthoracic echocardiography in only half of the patients. Intraoperative transesophageal echocardiography provided a more effective means to identify this disease. Radical resection of all infected tissues for patients with multivalvular endocarditis and additional intraoperative interventions, depending on the intraoperative pathologic condition, produced satisfactory in-hospital and long-term results, similar to those in patients with a single infected heart valve.
authors.affiliation: Department of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China.
authors.forename: Feng
authors.initials: F
authors.lastname: Yao
authors.forename: Lin
authors.initials: L
authors.lastname: Han
authors.forename: Zhi-yun
authors.initials: ZY
authors.lastname: Xu
authors.forename: Liang-jian
authors.initials: LJ
authors.lastname: Zou
authors.forename: Sheng-dong
authors.initials: SD
authors.lastname: Huang
authors.forename: Zhi-nong
authors.initials: ZN
authors.lastname: Wang
authors.forename: Fang-lin
authors.initials: FL
authors.lastname: Lu
authors.forename: Ying-long
authors.initials: YL
authors.lastname: Yao
mesh_terms: D000328:Adult; D001705:Bioprosthesis; D004697:Endocarditis, Bacterial / Q000401:mortality / Q000601:surgery*; D005260:Female; D006349:Heart Valve Diseases / Q000401:mortality / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation; D006351:Heart Valves / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012008:Recurrence; D012086:Reoperation; D015996:Survival Rate