title: Surgical outcomes in native valve infectious endocarditis: the experience of the Cardiovascular Surgery Department - Cluj-Napoca Heart Institute.
abstract: OBJECTIVE
  The introduction of Duke's criteria and the improvement of imaging methods has lead to an earlier and a more accurate diagnosis of infectious endocarditis (IE). The options for the best therapeutic approach and the timing of surgery are still a matter of debate and require a close colaboration between the cardiologist, the infectionist and the cardiac surgeon.
  
  
  METHODS
  We undertook a retrospective, descriptive study, spanning over a period of five years (from January 1st, 2007 to December 31st, 2012), on 100 patients who underwent surgery for native valve infectious endocarditis in our unit.
  
  
  RESULTS
  The patients' age varied between 13 and 77 years (with a mean of 54 years), of which 85 were males (85%). The main microorganisms responsible for IE were: Streptococcus Spp. (21 cases - 21%), Staphylococcus Spp. (15 cases - 15%), and Enterococcus Spp. (9 cases - 9%). The potential source of infection was identified in 26 patients (26%), with most cases being in the dental area (16 cases - 16%). The lesions caused by IE were situated in the left heart in 96 patients (96%), mostly on the aortic valve (50 cases - 50%). In most cases (82%) we found preexisting endocardial lesions which predisposed to the development of IE, most of them being degenerative valvular lesions (38 cases - 38%). We performed the following surgical procedures: surgery on a single valve - aortic valve replacement (40 cases), mitral valve replacement (19 cases), mitral valve repair (1 case), surgery on more than one valve - mitral and aortic valve replacement (20 cases), aortic and tricuspid valve replacement (1 case), aortic valve replacement with a mechanical valve associated with mitral valve repair (5 cases), aortic valve replacement with a biological valve associated with mitral valve repair (2 cases), and mitral valve replacement with a mechanical valve combined with De Vega procedure on the tricuspid valve (1 case). In 5 patients (5%) the bacteriological examination of valve pieces excised during surgery was positive. In 3 cases it matched the germ identified in the hemocultures, and in 2 cases it evidenced another bacterium.
  
  
  CONCLUSIONS
  The overall mortality of 5% is well between the limits presented in literature, being higher (30%) in patients who required emergency surgery. For the patients who return into our clinic with prosthetic valve endocarditis, the mortality after surgery was even higher (50%).
authors.affiliation: Cardiovascular Surgery Department, Heart Institute Cluj-Napoca, Romania ; Cardiovascular Surgery Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
authors.forename: Adrian
authors.initials: A
authors.lastname: Molnar
authors.affiliation: Cardiovascular Surgery Department, Heart Institute Cluj-Napoca, Romania.
authors.forename: Ioan
authors.initials: I
authors.lastname: Muresan
authors.affiliation: Cardiovascular Surgery Department, Heart Institute Cluj-Napoca, Romania.
authors.forename: Catalin
authors.initials: C
authors.lastname: Trifan
authors.affiliation: Cardiology Department, Clinical Rehabilitation Hospital, Cluj-Napoca, Romania.
authors.forename: Dana
authors.initials: D
authors.lastname: Pop
authors.affiliation: Cardiovascular Surgery Department, Heart Institute Cluj-Napoca, Romania.
authors.forename: Diana
authors.initials: D
authors.lastname: Sacui
keywords: antibiotic therapy; emergency surgery; infectious endocarditis; mortality