title: In-hospital prognosis of prosthetic valve endocarditis after urgent surgery.
abstract: OBJECTIVE
  Prosthetic valve endocarditis is associated with high morbidity and mortality, particularly when urgent surgery is needed. The identification of factors that predict a poor prognosis is the first step in improving outcomes. The study objectives were to characterize patients with prosthetic valve endocarditis who need urgent surgery and to identify factors that predict in-hospital mortality in this high-risk group.
  
  
  METHODS
  From a database of 648 consecutive patients with infective endocarditis diagnosed between 1996 and 2006 at four tertiary-care centers with cardiac surgery facilities, 46 patients with left-sided prosthetic valve endocarditis who needed urgent surgery were identified. A retrospective study was carried out to determine these patients' main characteristics and to identify predictors of in-hospital mortality.
  
  
  RESULTS
  The main indications for urgent surgery were heart failure (57%) and persistent infection (33%). In-hospital mortality was 41%. Factors significantly associated with a poor prognosis were fever at admission, persistent infection, positive blood cultures, persistently positive cultures, and echocardiographic evidence of vegetations (P< .05). No specific microorganism was associated with a poor prognosis.
  
  
  CONCLUSIONS
  Prosthetic valve endocarditis was associated with high mortality when urgent surgery was needed. Although heart failure was the principle reason for urgent surgery, it did not lead to a worse in-hospital prognosis. The presence of vegetations and uncontrolled infection were the main factors associated with higher in-hospital mortality in patients with left-sided infective endocarditis who needed urgent surgery.
authors.affiliation: Servicio de Cardiología y Cirugía Cardiaca, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario, 47005 Valladolid, España. arevillaorodea@gmail.com
authors.forename: Ana
authors.initials: A
authors.lastname: Revilla
authors.forename: Javier
authors.initials: J
authors.lastname: López
authors.forename: Teresa
authors.initials: T
authors.lastname: Sevilla
authors.forename: Eduardo
authors.initials: E
authors.lastname: Villacorta
authors.forename: Cristina
authors.initials: C
authors.lastname: Sarriá
authors.forename: María del Carmen
authors.initials: Mdel C
authors.lastname: Manzano
authors.forename: Enrique
authors.initials: E
authors.lastname: Fulquet
authors.forename: Eduardo
authors.initials: E
authors.lastname: Pozo
authors.forename: Pedro
authors.initials: P
authors.lastname: Mota
authors.forename: Itzíar
authors.initials: I
authors.lastname: Gómez
authors.forename: Isidre
authors.initials: I
authors.lastname: Vilacosta
authors.forename: José A
authors.initials: JA
authors.lastname: San Román
mesh_terms: D000328:Adult; D000368:Aged; D004638:Emergency Treatment; D004696:Endocarditis / Q000382:microbiology* / Q000401:mortality*; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016459:Prosthesis-Related Infections / Q000401:mortality*; D012189:Retrospective Studies