title: Surgical treatment for infective endocarditis and hospital mortality in a Brazilian single-center.
abstract: OBJECTIVE
  We evaluated patients underwent cardiac valve surgery in the presence of infective endocarditis in an attempt to identify independent predictors of 30-day mortality.
  
  
  METHODS
  We evaluated 837 consecutive patients underwent cardiac valve surgery from January 2003 to May 2010 in a tertiary hospital in São José do Rio Preto, São Paulo (SP), Brazil. The study group comprised patients who underwent intervention in the presence of infective endocarditis and was compared to the control group (without infective endocarditis), evaluating perioperative clinical outcomes and 30-day all cause mortality.
  
  
  RESULTS
  In our series, 64 patients (8%) underwent cardiac valve surgery in the presence of infective endocarditis, and 37.5% of them had surgical intervention in multiple valves. The study group had prolonged ICU length of stay (16%), greater need for dialysis (9%) and higher 30-day mortality (17%) compared to the control group (7%, P=0.020; 2%, P=0.002 and 9%, P=0.038; respectively). In a Cox regression analysis, age (P = 0.007), acute kidney injury (P = 0.004), dialysis (P = 0.026), redo surgery (P = 0.026), re-exploration for bleeding (P = 0.013), tracheal reintubation (P <0.001) and type I neurological injury (P <0.001) were identified as independent predictors for death. Although the manifestation of infective endocarditis influenced on mortality in univariate analysis, multivariate Cox regression analysis did not confirm such variable as an independent predictor of death.
  
  
  CONCLUSIONS
  Age and perioperative complications stand out as predictors of hospital mortality in Brazilian population. Cardiac valve surgery in the presence of active infective endocarditis was not confirmed itself as an independent predictor of 30-day mortality.
authors.affiliation: Cardiac Intensive Care Unit from Hospital de Base, São José do Rio Preto Medical School, São José do Rio Preto, SP, Brazil. maunmac@gmail.com
authors.forename: Maurício Nassau
authors.initials: MN
authors.lastname: Machado
authors.forename: Marcelo Arruda
authors.initials: MA
authors.lastname: Nakazone
authors.forename: Jamil Ali
authors.initials: JA
authors.lastname: Murad-Júnior
authors.forename: Lilia Nigro
authors.initials: LN
authors.lastname: Maia
mesh_terms: D000328:Adult; D000367:Age Factors; D001938:Brazil / Q000453:epidemiology; D004696:Endocarditis / Q000401:mortality* / Q000601:surgery*; D004812:Epidemiologic Methods; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D059035:Perioperative Period / Q000009:adverse effects / Q000401:mortality; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome