title: Outcomes of double valve surgery for active infective endocarditis.
abstract: OBJECTIVE
  In active infective endocarditis the need for operating simultaneously on the aortic and mitral valves is frequent. There are no studies in the literature documenting long-term outcomes of double valve surgery for active endocarditis.
  
  
  METHODS
  Ninety patients underwent double valve surgery for active endocarditis over a 26-year period (mean age, 53 +/- 16 years; 71% male patients). Prosthetic endocarditis was seen in 32 patients. Staphylococcus species was isolated in 29%. Forty-six (51%) patients had abscesses. Surgical intervention consisted of valve repair or replacement with limited infection or radical resection, patch reconstruction, and valve replacement for abscesses. Mean follow-up was 5.9 +/- 4.7 years (range, 0-18 years) and was complete.
  
  
  RESULTS
  There were 14 (15.6%) in-hospital deaths and 29 (32.2%) late deaths. Overall survival at 5, 7, and 10 years was 68% +/- 5%, 59% +/- 6%, and 49% +/- 6%, respectively, and was reduced in those undergoing operations for prosthetic compared with native endocarditis (7-year survival, 39% +/- 9% vs 71% +/- 7%; P < .001). Freedom from recurrent endocarditis was 84% +/- 5% at 10 years. Freedom from reoperation was 91% +/- 4% at 10 years. Event-free survival at 7 and 10 years was 60% +/- 6% and 47% +/- 7%, respectively. No difference was observed between the native and prosthetic groups for recurrent endocarditis, late reoperation, or event-free survival. Prosthetic endocarditis, increasing age, preoperative shock, and diabetes mellitus were independent predictors of death from all causes.
  
  
  CONCLUSIONS
  Double valve surgery for active endocarditis remains technically challenging and associated with significant morbidity and mortality perioperatively and in the longer term. Outcomes are worse in those who have prosthetic valve endocarditis.
authors: Division of Cardiovascular Surgery, Toronto General Hospital, Toronto, Ontario, Canada.
authors: Amir M
authors: AM
authors: Sheikh
authors: Abdelsalam M
authors: AM
authors: Elhenawy
authors: Manjula
authors: M
authors: Maganti
authors: Susan
authors: S
authors: Armstrong
authors: Tirone E
authors: TE
authors: David
authors: Christopher M
authors: CM
authors: Feindel
mesh_terms: D001021:Aortic Valve / Q000601:surgery*; D001705:Bioprosthesis; D006348:Cardiac Surgical Procedures / Q000401:mortality; D004697:Endocarditis, Bacterial / Q000401:mortality / Q000601:surgery*; D005260:Female; D006349:Heart Valve Diseases / Q000401:mortality / Q000601:surgery*; D006350:Heart Valve Prosthesis / Q000009:adverse effects; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D011183:Postoperative Complications; D016459:Prosthesis-Related Infections / Q000601:surgery; D015996:Survival Rate; D016896:Treatment Outcome