title: Midterm surgical outcomes of noncomplicated active native multivalve endocarditis: single-center experience.
abstract: BACKGROUND
  Surgical treatment for endocarditis is still challenging and only a handful of studies have analyzed surgical outcomes in patients with active multivalvular endocarditis.
  
  
  METHODS
  From June 1996 to October 2007, 152 patients underwent surgery for active native valve endocarditis; 117 patients with single-valve endocarditis and 35 patients with multivalvular endocarditis. Preoperative and postoperative data were retrospectively reviewed to determine risk factors for early and late mortality.
  
  
  RESULTS
  One-year and 5-year survival were 78.6%±3.8% and 54.8%±5.3% in the single-valve group, and 74.3%±7.4% and 64.8%±8.3% in the multivalve group, respectively (log-rank 0.64). The rates of valve replacement were significantly higher in the single-valve group than in the multivalve group in all sites except the pulmonary valve. Freedom from reoperation was 90.0%±3.6% in the single-valve group and 79.5%±8.5% in the multivalve group in 5 years (log-rank 0.30). No recurrence of endocarditis was noted in the multivalve group, while 4 patients (3.4%) had recurrence in the single-valve group during the follow-up period (p=0.57). There was no significant difference in postoperative complications between the two groups. Multivariate analysis of the multivalve group identified postoperative renal failure as a predictor of late mortality with no predictors identified for early mortality, reoperation, and recurrence. Statistical analysis of the overall cohorts showed multivalve endocarditis was not an independent predictor of early and late mortality.
  
  
  CONCLUSIONS
  Surgical treatment for active, native, and noncomplicated multivalve endocarditis was associated with respectable early and late morbidity and mortality comparable with single-valve endocarditis, and was not an independent predictor of early and late mortality.
authors.affiliation: Department of Cardiothoracic Surgery, Division of Cardiac Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA.
authors.forename: Takeyoshi
authors.initials: T
authors.lastname: Ota
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Gleason
authors.forename: Stefano
authors.initials: S
authors.lastname: Salizzoni
authors.forename: Lawrence M
authors.initials: LM
authors.lastname: Wei
authors.forename: Yoshiya
authors.initials: Y
authors.lastname: Toyoda
authors.forename: Christian
authors.initials: C
authors.lastname: Bermudez
mesh_terms: D000328:Adult; D015331:Cohort Studies; D016001:Confidence Intervals; D004697:Endocarditis, Bacterial / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000382:microbiology / Q000401:mortality* / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods / Q000401:mortality; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications / Q000401:mortality; D016016:Proportional Hazards Models; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome