title: Characteristics and prognosis of patients requiring valve surgery during active infective endocarditis.
abstract: OBJECTIVE
  The study aim was to describe the characteristics and operative mortality of patients requiring valve surgery during active infective endocarditis (IE).
  
  
  METHODS
  This retrospective analysis involved 141 surgically treated patients with active IE. All cardiac operations were performed by the same surgical team between January 1998 and July 2009. All patients had definite (n = 128) or possible (n = 13) endocarditis according to modified Duke criteria. The IE was considered active if surgery was required before completion of a standard course of antimicrobial therapy. Operative mortality included any death occurring within the same hospital admission as surgery.
  
  
  RESULTS
  Among the patients (108 males, 33 females; mean age 56.3 +/- 14.9 years), native valve endocarditis was present in 122 cases (87%). Multiple valve involvement was observed in 27 patients. The infected valves were the aortic (n = 81), mitral (n = 70), tricuspid (n = 15), or pulmonary (n = 2). The most common pathogens were staphylococci (n = 49), streptococci (n = 46) and enterococci (n = 27). The operative mortality was 16%. In univariate analysis, factors linked to operative mortality were age, prosthetic valve endocarditis (PVE) and inadequate antimicrobial therapy. In multivariate analysis, only PVE was an independent adverse predictor (adjusted Odds Ratio = 4.16; 95% confidence intervals 1.14-12.2; p = 0.01).
  
  
  CONCLUSIONS
  Surgery for active IE is associated with a high mortality rate. The prognosis is impaired in patients with PVE, but might be improved by adequate antimicrobial therapy.
authors.affiliation: Pôle de Chirurgie Cardiovasculaire, CHRU de Lille and Hôpital Cardiologique, CHRU de Lille, France. g.fayad@sfr.fr
authors.forename: Georges
authors.initials: G
authors.lastname: Fayad
authors.forename: Guillaume
authors.initials: G
authors.lastname: Leroy
authors.forename: Patrick
authors.initials: P
authors.lastname: Devos
authors.forename: Erik
authors.initials: E
authors.lastname: Hervieux
authors.forename: Eric
authors.initials: E
authors.lastname: Senneville
authors.forename: Mohamad
authors.initials: M
authors.lastname: Koussa
authors.forename: Olivier
authors.initials: O
authors.lastname: Leroy
mesh_terms: D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D004697:Endocarditis, Bacterial / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D005260:Female; D005602:France; D006349:Heart Valve Diseases / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D006351:Heart Valves / Q000382:microbiology / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D016459:Prosthesis-Related Infections / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000890:Anti-Infective Agents