Outcomes after surgical treatment of native and prosthetic valve infective endocarditis.
BACKGROUND
The risk of death and complications of infective endocarditis (IE) treated medically has to be balanced against those from surgery in constructing a therapeutic approach. Recent literature has drawn conflicting conclusions on the benefit of surgery for IE. We reviewed patients treated surgically for IE at the Cleveland Clinic from 2003 to 2007 to examine their outcomes.


METHODS
A retrospective review of consecutive patients who underwent surgery for native and prosthetic valve endocarditis between January 1, 2003, and December 31, 2007, was conducted. Surgical outcomes were reviewed to include survival and postoperative complications. Survival was evaluated at end of hospital stay, 30 days, 1 year, and at last follow-up.


RESULTS
Four hundred twenty-eight patients underwent surgery for IE during the study period: 248 (58%) had native valve endocarditis and 180 (42%) had prosthetic valve endocarditis. Overall 90% of patients survived to hospital discharge. When compared with patients with native valve infection, patients with prosthetic infection had significantly higher 30-day mortality (13% versus 5.6%; p<0.01), but long-term survival was not significantly different (35% versus 29%; p=0.19). Patients with IE caused by Staphylococcus aureus had significantly higher hospital mortality (15% versus 8.4%; p<0.05), 6-month mortality (23% versus 15%; p=0.05), and 1-year mortality (28% versus 18%; p=0.02) compared with non-S aureus IE.


CONCLUSIONS
Surgical treatment of IE was associated with 90% hospital survival. Outcomes within the 30 days were better for native valve than for prosthetic valve endocarditis. Long-term outcomes were similar. Finally, S aureus was associated with significantly higher mortality compared with other pathogens.
Department of Internal Medicine, Medicine Institute, The Cleveland Clinic, Cleveland, Ohio 44195, USA. mannem@ccf.org
Mahesh B
MB
Manne
Nabin K
NK
Shrestha
Bruce W
BW
Lytle
Edward R
ER
Nowicki
Eugene
E
Blackstone
Steven M
SM
Gordon
Gosta
G
Pettersson
Thomas G
TG
Fraser
D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use; D001022:Aortic Valve Insufficiency / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D016470:Bacteremia / Q000453:epidemiology; D001705:Bioprosthesis / Q000009:adverse effects; D003131:Combined Modality Therapy; D015897:Comorbidity; D003646:Debridement; D004696:Endocarditis / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis / Q000009:adverse effects; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D016459:Prosthesis-Related Infections / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D015819:Substance Abuse, Intravenous / Q000150:complications; D016896:Treatment Outcome; D014262:Tricuspid Valve Insufficiency / Q000453:epidemiology / Q000209:etiology / Q000601:surgery
D000890:Anti-Infective Agents