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European Journal of Cardio-Thoracic Surgery, Vol 11, 46-52, Copyright © 1997 by European Association for Cardio-thoracic Surgery
Y d'Udekem, TE David, CM Feindel, S Armstrong and Z Sun
OBJECTIVE: This paper was undertaken to determine the long-term outcome of
active infective endocarditis treated with antibiotic and radical excision
of infected tissues by surgery. METHODS: From October 1978 to August 1994,
122 consecutive patients were operated on during the acute phase of
infective endocarditis. There were 85 men and 37 women whose mean age was
50 years, ranging from 20 to 79. Surgery was needed because of one or more
of the following complications: cardiogenic/septic shock in 19 patients,
congestive heart failure in 68, persistent sepsis in 64, peripheral
embolization in 20, and cerebral embolization in 10. The offending
microorganism was identified in 110 patients, staphylococci were the most
common ones. Seventy-six patients had native valve endocarditis and 46 had
prosthetic valve endocarditis. Simple valve replacement or repair was
performed in 60 patients and radical resection of the valve and surrounding
tissues with reconstruction of the heart with either fresh autologous
pericardium or glutaraldehyde-fixed bovine pericardium was performed in 62
with paravalvular abscess. Pulmonary autograft and aortic homograft were
used in only three patients, the remaining patients had either
bioprostheses or mechanical heart valves if valve repair was not feasible.
RESULTS: There were nine deaths, for an operative mortality of 7.4%.
Logistic regression analysis identified preoperative shock and renal
failure as predictors of operative mortality. Operative survivors were
followed up from 4 to 173 months, mean of 56.4. The actuarial survival at
10 years was 61 +/- 6%. Logistic regression analysis identified
preoperative New York Heart Association functional class IV and
perioperative renal failure as predictors of late mortality. Eight patients
developed recurrent endocarditis 10-102 months postoperatively. The freedom
from recurrent endocarditis at 10 years was 79 +/- 9%. All patients who
developed this late complication had paravalvular abscess at the time of
original operation. CONCLUSIONS: These data suggest that surgery for active
infective endocarditis yield a high probability of eradicating the
infection with relatively low operative mortality and good long-term
results.
ARTICLES
Long-term results of surgery for active infective endocarditis
Division of Cardiovascular Surgery of The Toronto Hospital, University of Toronto, Ontario, Canada.
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