title: Surgical treatment of double valve endocarditis.
abstract: BACKGROUND
  We have retrospectively analyzed the results of the operations made for aortic infective endocarditis with mitral involvement in a single center in 19 years.
  
  
  METHODS
  From May 1992 to January 2011, we have operated on 72 patients with infective endocarditis of the aortic valve with mitral valve involvement. Fifty-two patients (72.2%) were male and the mean age was 40.5 ± 15.5 (9-73) years. The blood cultures were positive in 33 patients (45.8%) and the most commonly identified microorganism was Streptococcus. Nine patients (12.5%) had prosthetic valve endocarditis. The mean duration of follow-up was 6.8 ± 4.7 (0.1-16.9) years, adding up to a total of 156.1 patient/years.
  
  
  RESULTS
  A total of 155 procedures were performed on these 72 patients. The most commonly performed procedure was aortic valve replacement, in 63 patients (87.5%). Aortic annular involvement was present in 9 cases (12.5%). In-hospital mortality was seen in 13 patients (18.1%). Postoperatively, 13 (18.1%) patients had low cardiac output, 9 (12.5%) had heart block, and only 1 of them required permanent pacemaker implantation. The actuarial survival rates for 1, 5, and 10 years were 96.4% ± 2.5%, 84.4% ± 5.1%, and 77.4 ± 6.7%, respectively.
  
  
  CONCLUSIONS
  Double-valve endocarditis is a serious condition and the surgeon must be aware of the high rates of mortality and morbidity in these patients. Although no association was found, heart blocks and septic embolization must be handled with caution. The patients generally do well after surgery, and recurrences and reoperations decrease by the second year after operation.
authors.affiliation: Cardiovascular Surgery Clinic, Kartal Kosuyolu Research and Training Hospital, Istanbul, Turkey.
authors.forename: Serpil
authors.initials: S
authors.lastname: Tas
authors.affiliation: Cardiovascular Surgery Clinic, Kartal Kosuyolu Research and Training Hospital, Istanbul, Turkey.
authors.forename: Taylan
authors.initials: T
authors.lastname: Adademir
authors.affiliation: Cardiovascular Surgery Clinic, Kartal Kosuyolu Research and Training Hospital, Istanbul, Turkey.
authors.forename: Eylem Yayla
authors.initials: EY
authors.lastname: Tuncer
authors.affiliation: Cardiovascular Surgery Clinic, Kartal Kosuyolu Research and Training Hospital, Istanbul, Turkey.
authors.forename: Arzu Antal
authors.initials: AA
authors.lastname: Donmez
authors.affiliation: Cardiovascular Surgery Clinic, Bakırkoy Dr. Sadi Konuk Research and Training Hospital, Istanbul, Turkey.
authors.forename: Ebru Bal
authors.initials: EB
authors.lastname: Polat
authors.affiliation: Cardiovascular Surgery Clinic, Kartal Kosuyolu Research and Training Hospital, Istanbul, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Aksut
authors.affiliation: Cardiovascular Surgery Clinic, Yuksek Ihtisas Hospital, Ankara, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Songur
authors.affiliation: Cardiovascular Surgery Clinic, Kartal Kosuyolu Research and Training Hospital, Istanbul, Turkey.
authors.forename: Altug
authors.initials: A
authors.lastname: Tuncer
authors.affiliation: Cardiovascular Surgery Clinic, Kartal Kosuyolu Research and Training Hospital, Istanbul, Turkey.
authors.forename: Mesut
authors.initials: M
authors.lastname: Sismanoglu
mesh_terms: D000293:Adolescent; D001021:Aortic Valve / Q000601:surgery; D000082882:Bicuspid Aortic Valve Disease; D002648:Child; D004696:Endocarditis / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D006349:Heart Valve Diseases / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D016459:Prosthesis-Related Infections / Q000209:etiology* / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult