title: Long-term clinical outcomes and predictors of survival after prosthetic valve endocarditis surgery.
abstract: OBJECTIVE
  The study aim was to comprehend the outcomes of surgery for prosthetic valve endocarditis (PVE) over 25 years and to identify predictors for patient survival.
  
  
  METHODS
  A total of 47 consecutive patients (19 males, 28 females; mean age 67.0 +/- 11.5 years) whounderwent surgery for PVE between 1986 and 2011 was analyzed. Typically, PVE appeared at 4.2 +/- 6.2 years after valve replacement. Preoperative and postoperative clinical variables were evaluated; the mean follow up was 6.4 +/- 5.3 years.
  
  
  RESULTS
  The incidence of PVE was 3.9% for 1,185 cases of valve replacement through the study period. Operative mortality was 17.0%. NYHA functional class IV (p = 0.01), preoperative shock (p = 0.03) and renal failure (p = 0.02) were each independent predictors of operative mortality. Survival was 69.1 +/- 9.3% at 10 years and 59.2 +/- 12.1% at both 15 and 20 years. Preoperative impaired left ventricular function (p = 0.02) and preoperative renal failure (p = 0.04) were independent predictors of late mortality. Freedom from recurrent PVE remained at 82.5 +/- 6.0% from two years up to 20 years after surgery. Initial infective endocarditis (p = 0.03) and postoperative heart failure (p = 0.04) were predictors of recurrent PVE. Freedom from reoperation was 84.8 +/- 5.7% at 10 years, and 72.6 +/- 12.2% at both 15 and 20 years.
  
  
  CONCLUSIONS
  This extensive examination revealed that critical preoperative conditions determine not only short-term but also long-term mortality after surgery to treat PVE. Hence, a timely surgical intervention and close follow up are crucial for patient survival.
authors.affiliation: Department of Cardiovascular Surgery, Tenri Hospital, Nara 632-8552, Japan. mnonaka0725@hotmail.co.jp
authors.forename: Michihito
authors.initials: M
authors.lastname: Nonaka
authors.affiliation: Department of Cardiovascular Surgery, Tenri Hospital, Nara 632-8552, Japan.
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Kusuhara
authors.affiliation: Department of Cardiovascular Surgery, Tenri Hospital, Nara 632-8552, Japan.
authors.forename: Kenta
authors.initials: K
authors.lastname: An
authors.affiliation: Department of Cardiovascular Surgery, Tenri Hospital, Nara 632-8552, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Nakatsuka
authors.affiliation: Department of Cardiovascular Surgery, Tenri Hospital, Nara 632-8552, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Sekine
authors.affiliation: Department of Cardiovascular Surgery, Tenri Hospital, Nara 632-8552, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Iwakura
authors.affiliation: Department of Cardiovascular Surgery, Tenri Hospital, Nara 632-8552, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Yamanaka
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004697:Endocarditis, Bacterial / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000453:epidemiology* / Q000209:etiology; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors