title: Outcome after surgery for prosthetic valve endocarditis and the impact of preoperative treatment.
abstract: OBJECTIVE
  This study examined the outcomes of surgery for active prosthetic valve endocarditis in a recent decade, with special interest in preoperative treatment and predictors for early and late events.
  
  
  METHODS
  From 2000 to 2010, a cohort of 149 consecutive patients (mean age, 64±13.9 years; 72% were male) underwent redo-surgery for prosthetic valve endocarditis and were reviewed regarding early (≤60 days) and late (>60 days) events (death, reinfection, reoperation). Kaplan-Meier survival curves and Cox regression analysis were used to investigate the impact of preoperative intervals and predictors for events, respectively.
  
  
  RESULTS
  Preoperative status was critical (European System for Cardiac Operative Risk Evaluation>20%) in 121 patients (81.2%). Staphylococci were the most common infecting microorganisms (27.5%). The median interval between onset of symptoms and diagnosis and between diagnosis and operation was 2 days (interquartile range, 1-5) and 8 days (interquartile range, 2-23), respectively. Operative mortality (≤30 days) was 12.8%. Mean follow-up was 4±2.9 years. In 53 patients, 47 early (24 deaths, 14 recurrences, 9 reoperations) and 22 late events (11 deaths, 9 recurrences, 2 reoperations) occurred. Overall and event-free survivals at 10 years were 75%±3.8% and 64%±4.0%, respectively. Freedom from recurrent infection and reoperation at 10 years were 81%±3.6% and 91%±2.6%, respectively. In multivariate Cox regression, mechanical circulatory support, prolongation between onset of symptoms and diagnosis more than 30 days, and preoperative presence of renal failure predicted early events, and double valve replacement predicted late events.
  
  
  CONCLUSIONS
  Cardiac and renal function, need for double valve replacement, and preoperative treatment predicted outcomes. A prolonged interval in which patients were left untreated while symptomatic, but not prolongation of preoperative antibiotic treatment, increased risk.
authors.affiliation: Klinik für Kardiovaskuläre Chirurgie. Electronic address: herko.grubitzsch@charite.de.
authors.forename: Herko
authors.initials: H
authors.lastname: Grubitzsch
authors.affiliation: Klinik für Kardiovaskuläre Chirurgie.
authors.forename: Andreas
authors.initials: A
authors.lastname: Schaefer
authors.affiliation: Medizinische Klinik mit Schwerpunkt Kardiologie und Angiologie, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Melzer
authors.affiliation: CRO SOSTANA GmbH, Berlin, Germany.
authors.forename: Klaus-Dieter
authors.initials: KD
authors.lastname: Wernecke
authors.affiliation: Dipartimento di Cardiochirurgia, Hesperia Hospital, Modena, Italia.
authors.forename: Davide
authors.initials: D
authors.lastname: Gabbieri
authors.affiliation: Klinik für Kardiovaskuläre Chirurgie.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Konertz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D018572:Disease-Free Survival; D004697:Endocarditis, Bacterial / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents