title: Clinical Presentation of Native Mitral Valve Infective Endocarditis Determines Long-Term Outcome after Surgery.
abstract: OBJECTIVE
  Surgery is performed in up to half of all cases of active infective endocarditis (IE) but the associated mortality remains high. The aim was to examine the effect of the preoperative clinical presentation on long-term survival of patients undergoing surgery for isolated native mitral valve infective endocarditis.
  
  
  METHODS
  A retrospective study was conducted on 100 patients who had undergone mitral valve surgery from 1998 to 2014 for ongoing isolated, native valve IE. Patients were stratified depending on preoperative symptoms: clinical stroke due to septic cerebral embolism, congestive heart failure, and uncontrolled bacteremia. Group A had none of the clinical symptoms, Group B had one of the above clinical symptoms, and Group C had ≥2 symptoms. Follow-up was 100% complete for survival (median 3.8 years, IQR 0.8-7.7). Event rates were estimated with the Kaplan-Meier method and Cox-regression was performed.
  
  
  RESULTS
  Overall 30-day mortality was 5% (n = 5); 0% in Group A; 8% in Group B (n = 4); and 8% in Group C (n = 1), p = 0.24. Five-year survival was 87.0 ± 6.1% in Group A, 62.6 ± 7.1% in Group B, and 33.8 ± 15.2% in Group C. Grouping by clinical presentation was found to be an independent predictor of mortality (Group B, HR 2.37, 95% CI 1.02-5.50; Group C, HR 4.07, 95% CI 1.56-10.6).
  
  
  CONCLUSIONS
  Long-term survival after surgery for native mitral valve IE was independently influenced by the presence of preoperative embolic stroke, congestive heart failure or uncontrolled bacteremia alone, or in combination.
authors.affiliation: Department of Cardiothoracic Surgery, Skane University Hospital and Lund University, Lund, Sweden.
authors.forename: Sigurdur
authors.initials: S
authors.lastname: Ragnarsson
authors.affiliation: Department of Cardiothoracic Surgery, Skane University Hospital and Lund University, Lund, Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Sjögren
authors.affiliation: Department of Cardiology, Skane University Hospital and Lund University, Lund, Sweden.
authors.forename: Martin
authors.initials: M
authors.lastname: Stagmo
authors.affiliation: Department of Cardiothoracic Surgery, Skane University Hospital and Lund University, Lund, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Wierup
authors.affiliation: Department of Cardiothoracic Surgery, Skane University Hospital and Lund University, Lund, Sweden.
authors.forename: Shahab
authors.initials: S
authors.lastname: Nozohoor
mesh_terms: D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000150:complications; D006348:Cardiac Surgical Procedures / Q000401:mortality*; D004696:Endocarditis / Q000150:complications / Q000401:mortality* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006333:Heart Failure / Q000150:complications; D006801:Humans; D020766:Intracranial Embolism / Q000150:complications; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D057234:Preoperative Period; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome