title: Surgical management of infective endocarditis: early and long-term mortality analysis. single-center experience and brief literature review.
abstract: BACKGROUND
  In this study we evaluated factors that affect the early and long-term postoperative outcomes of patients with infective endocarditis.
  
  
  METHODS
  We retrospectively reviewed 94 patients (68 male, 26 female, mean age 58.3 ± 13.1 years, range 20-85 years) with proven infective native (n=85) or prosthetic valve (n=9) endocarditis who underwent heart valve surgery between September 1997 and December 2007. Fifty-four patients (57.4%) underwent aortic, 28 (29.8%) mitral, 3 (3.2%) tricuspid, 8 (8.5%) double, and one patient (1%) triple valve surgery. In 75.5% of the procedures we implanted mechanical valves, in 13.8% biological prostheses, and 10.7% were reconstructive or other procedures. Midterm follow up was 100% complete with a cumulative duration of 545 patient-years (maximum 12 years).
  
  
  RESULTS
  Overall hospital mortality (30 days) was 8.5% (n=8). Causes of early mortality were low cardiac output syndrome in 2 cases, sepsis with multiple organ failure in 5 cases, and intracerebral bleeding in one patient. Development of postoperative low cardiac output syndrome (p=0.01) was identified as an independent predictor of early mortality. Overall late mortality was 25.6% (n=22) with a cumulative rate of 4.03% per patient-year. Causes of late death were predominantly of extracardiac origin. Kaplan-Meier survival analysis revealed a cumulative survival rate at 12 years of 57.2%. Cox regression analysis identified diabetes mellitus (p=0.016) and postoperative low cardiac output syndrome (p=0.03) as independent late mortality factors.
  
  
  CONCLUSIONS
  Heart valve surgery in patients with infective endocarditis is associated with increased but acceptable early and long-term mortality. The mid-term prognosis is similar to that of patients undergoing elective valve replacement surgery.
authors.affiliation: Department of Cardiovascular Surgery, Heart Center, Klinikum München Bogenhausen GmbH, Munich, Germany.
authors.forename: Kyriakos
authors.initials: K
authors.lastname: Spiliopoulos
authors.forename: Gregory
authors.initials: G
authors.lastname: Giamouzis
authors.forename: Ayman
authors.initials: A
authors.lastname: Haschemi
authors.forename: Dimos
authors.initials: D
authors.lastname: Karangelis
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Antonopoulos
authors.forename: Gabriel
authors.initials: G
authors.lastname: Fink
authors.forename: Bernhard M
authors.initials: BM
authors.lastname: Kemkes
authors.forename: Brigitte
authors.initials: B
authors.lastname: Gansera
mesh_terms: D000328:Adult; D000368:Aged; D002423:Cause of Death; D004696:Endocarditis / Q000209:etiology / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006115:Greece / Q000453:epidemiology; D006350:Heart Valve Prosthesis / Q000009:adverse effects / Q000706:statistics & numerical data; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D006351:Heart Valves / Q000601:surgery; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000209:etiology; D015996:Survival Rate