title: Outcomes and prosthesis choice for active aortic valve infective endocarditis: analysis of the Society of Thoracic Surgeons Adult Cardiac Surgery Database.
abstract: BACKGROUND
  National prosthesis use in active aortic valve infective endocarditis (IE) is unreported. Prosthesis usage and outcomes in patients undergoing an aortic valve operation with active IE was evaluated.
  
  
  METHODS
  The Society of Thoracic Surgeons Adult Cardiac Surgery Database was used to identify patients with active IE who underwent an aortic valve operation from January 1, 2005, to June 30, 2011. All patients with active IE were included. Demographics, procedures, outcomes, and trends were analyzed.
  
  
  RESULTS
  Of 11,560 patients who were identified as having active IE, 8,421 (73%) had no prior operations (primary) and 3,139 (27%) had a history of any prior cardiac operation (reoperative). Operations for primary vs reoperative patients included isolated replacement in 88.5% vs 58.7% and root replacement in 7.2% vs 29.9%. Major morbidity was 60.8% vs 68%, and the unadjusted mortality rate was 9.8% vs 21.1%. Over time, for primary operations, biologic valve use increased (57% to 67%), and mechanical and homograft valve use decreased (30% to 24% and 9% to 6%; p < 0.001). For reoperations, biologic valve use increased (38% to 52%), and mechanical and homograft use decreased (20% to 17% and 38% to 28%; p < 0.001). Homografts were used more often in reoperations (32% vs 7%).
  
  
  CONCLUSIONS
  Morbidity and mortality rates death are high for operations for active IE. Biologic valves were increasingly used vs mechanical and homograft valves. Homograft valves were used more often in reoperative patients after any prior cardiac operation. The mortality rate varied among prosthesis groups but may be related to the severity of infection and type of procedure performed.
authors.affiliation: Department of Cardiothoracic Surgery, Cleveland Clinic Florida, Weston, Florida. Electronic address: edward.savage.md@gmail.com.
authors.forename: Edward B
authors.initials: EB
authors.lastname: Savage
authors.affiliation: Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina.
authors.forename: Paramita
authors.initials: P
authors.lastname: Saha-Chaudhuri
authors.affiliation: Department of Cardiology, Cleveland Clinic Florida, Weston, Florida.
authors.forename: Craig R
authors.initials: CR
authors.lastname: Asher
authors.affiliation: Division of Cardiology, Duke University Medical Center, Durham, North Carolina.
authors.forename: J Matthew
authors.initials: JM
authors.lastname: Brennan
authors.affiliation: Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: James S
authors.initials: JS
authors.lastname: Gammie
mesh_terms: D000328:Adult; D001021:Aortic Valve / Q000601:surgery*; D006348:Cardiac Surgical Procedures; D016208:Databases, Factual; D004696:Endocarditis / Q000601:surgery*; D005260:Female; D006349:Heart Valve Diseases / Q000382:microbiology / Q000601:surgery*; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D012955:Societies, Medical; D013903:Thoracic Surgery; D016896:Treatment Outcome