title: Infective Endocarditis With Paravalvular Extension: 35-Year Experience.
abstract: BACKGROUND
  We investigated our surgical strategy and clinical results in patients from active infective endocarditis (AIE) complicated by paravalvular involvement to determine the risk factors of early and late death and reoperation.
  
  
  METHODS
  From October 1979 to December 2014, 955 patients underwent operations for AIE; among them 207 had AIE with paravalvular extension. The patients were a mean age of 59.9 ± 15.4 years, and 162 (78%) were male. Of these patients, 137 (66%) had isolated aortic valve endocarditis, and 138 (67%) had native valve endocarditis. Follow-up was 99% complete.
  
  
  RESULTS
  The operative mortality of the cohort was 16% (n = 34). Abnormal communication, mechanical valve implantation, and renal failure were independent predictors of 30-day death. Survival at 1, 5, 10, and 15 years was 90.3% ± 2.3%, 62.4% ± 3.7%, 49.3% ± 4.1%, and 37.9% ± 4.4%, respectively. Streptococcus endocarditis (all species), complex annular repair, and preoperative heart failure were independent predictors of long-term death. A reoperation was required in 29 patients (14%). Streptococcus pneumoniae endocarditis was the only independent predictor of early reoperation (within 30 days after the operation or during the same hospitalization). Freedom from reoperation at 1, 5, 10, and 15 years was 91.9% ± 2.2%, 89.6% ± 2.6%, 89.6% ± 2.6%, and 87.0% ± 3.5%, respectively. Independent predictors of late reoperation were urgent/emergency operation, prosthetic valve endocarditis, and complex annular repair.
  
  
  CONCLUSIONS
  AIE complicated by paravalvular involvement remains a surgical challenge. Valve replacement (particularly using bioprosthesis) associated with ad hoc reconstruction seems to be a reliable option and showed very encouraging results in this context.
authors.affiliation: Department of Vascular and Cardio-Thoracic Surgery, Rennes University Health Centre, Rennes, France. Electronic address: simon.rouze@chu-rennes.fr.
authors.forename: Simon
authors.initials: S
authors.lastname: Rouzé
authors.affiliation: Department of Vascular and Cardio-Thoracic Surgery, Rennes University Health Centre, Rennes, France.
authors.forename: Erwan
authors.initials: E
authors.lastname: Flécher
authors.affiliation: Department of Infectious Diseases, Rennes University Health Centre, Rennes, France.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Revest
authors.affiliation: Department of Vascular and Cardio-Thoracic Surgery, Rennes University Health Centre, Rennes, France.
authors.forename: Amedeo
authors.initials: A
authors.lastname: Anselmi
authors.affiliation: Department of Vascular and Cardio-Thoracic Surgery, Rennes University Health Centre, Rennes, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Aymami
authors.affiliation: Department of Anaesthesiology and Intensive Care, Rennes University Health Centre, Rennes, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Roisné
authors.affiliation: Department of Vascular and Cardio-Thoracic Surgery, Rennes University Health Centre, Rennes, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Guihaire
authors.affiliation: Department of Vascular and Cardio-Thoracic Surgery, Rennes University Health Centre, Rennes, France.
authors.forename: Jean Philippe
authors.initials: JP
authors.lastname: Verhoye
mesh_terms: D001021:Aortic Valve / Q000601:surgery*; D001705:Bioprosthesis / Q000009:adverse effects*; D004696:Endocarditis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006349:Heart Valve Diseases / Q000601:surgery*; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011008:Pneumococcal Infections / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D012086:Reoperation; D013296:Streptococcus pneumoniae / Q000302:isolation & purification; D015996:Survival Rate / Q000639:trends