title: Long-term results after operations for active infective endocarditis in native and prosthetic valves.
abstract: BACKGROUND
  The objective of this study was to evaluate the midterm results of patients who underwent operations for active infective endocarditis.
  
  
  METHODS
  Within a 10-year period, 141 patients with active infective endocarditis received surgical therapy. We assessed outcome, freedom from reinfection, and freedom from reintervention. Prosthetic valve endocarditis was included in this series.
  
  
  RESULTS
  Surgical strategies included valve replacement with a tissue valve in 62% of patients and valve repair in 29% of patients. In 29% of patients, reconstruction of the aortomitral continuity, left ventricular outflow tract, or sinus of Valsalva was preferably performed with 1 or more bovine pericardial patches. In-hospital mortality was 11% and postoperative stroke rate was 7%. Multivariate logistic regression revealed multivalve involvement (p=0.052; odds ratio [OR], 5.84; 95% confidence interval [CI], 0.98-34.57), preoperative neurologic impairment (p=0.006; OR, 9.71; 95% CI, 1.92-49.09), and European system for cardiac operative risk evaluation (EuroSCORE) in quartiles (p=0.023; OR, 2.88; 95% CI, 1.15-7.17) to be independent predictors for in-hospital death. One-year and 5-year actuarial survival was 77% and 69%, respectively. One-year and 5-year actuarial freedom from reinfection was 100% and 90%, respectively. Freedom from reoperation at 5 years was 100%. Five-year survival was 74% for single-valve endocarditis and 46% for multivalve endocarditis (p<0.001). One-year freedom from reinfection was 100% for both single-valve and multivalve endocarditis; 5-year freedom from reinfection was 95% for single-valve endocarditis versus 67% for multivalve endocarditis (p=0.049).
  
  
  CONCLUSIONS
  Despite a high early mortality during the first year, surgical intervention for active infective endocarditis provided excellent results with regard to freedom from reinfection and reoperation. A strategy of extensive debridement, reconstruction of destroyed cardiac structures using xenopericardium, followed by valve replacement or repair is highly effective and shows favorable long-term outcomes.
authors: Department of Cardiovascular Surgery, University Hospital Berne, Berne, Switzerland.
authors: Katharina
authors: K
authors: Meszaros
authors: Sladjan
authors: S
authors: Nujic
authors: Gottfried H
authors: GH
authors: Sodeck
authors: Lars
authors: L
authors: Englberger
authors: Tobias
authors: T
authors: König
authors: Florian
authors: F
authors: Schönhoff
authors: David
authors: D
authors: Reineke
authors: Eva
authors: E
authors: Roost-Krähenbühl
authors: Jürg
authors: J
authors: Schmidli
authors: Martin
authors: M
authors: Czerny
authors: Thierry P
authors: TP
authors: Carrel
mesh_terms: D000328:Adult; D000368:Aged; D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002417:Cattle; D018572:Disease-Free Survival; D004452:Echocardiography; D004696:Endocarditis / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010496:Pericardium / Q000637:transplantation*; D011474:Prosthesis Design; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents