TY - JOUR
T1 - Early and Late Survival After Surgical Treatment of Culture-Positive Active Endocarditis
AU - Mullany, Charles J.
AU - Chua, Yeow L.
AU - Schaff, Hartzell V.
AU - Steckelberg, James M.
AU - Ilstrup, Duane M.
AU - Orszulak, Thomas A.
AU - Danielson, Gordon K.
AU - Puga, Francisco J.
PY - 1995
Y1 - 1995
N2 - To describe a 30-year experience with surgically treated culture-positive active endocarditis. We retrospectively reviewed the microbiologic, clinical, and operative findings and the survival data in 151 patients with culture-positive active endocarditis encountered between 1961 and 1991. The mean age of the 110 male and 41 female patients was 49.8 years. Native valve endocarditis was present in 86 patients, and prosthetic valve endocarditis (PVE) was diagnosed in 65. The aortic valve was involved in 62 % of patients, the mitral valve in 25%, and both valves in 10%. The operative mortality was 26%. The most important univariate determinants of mortality were an abscess at operation (P = 0.01) and renal failure (P = 0.03). A trend toward a higher mortality with PVE and staphylococcal infection was noted. For hospital survivors, the 5- and 10-year survival was 71 % and 60%, respectively. Univariate determinants of an adverse longterm survival were annular abscess (P = 0.01), renal impairment (P = 0.01), heart failure (P = 0.02), and aortic valve involvement (P = 0.05). On multivariate analysis, the most important adverse determinants of long-term survival were heart failure (P = 0.02), renal impairment (P = 0.02), and PVE (P = 0.03). Thirty patients required a subsequent reoperation; of these, seven required a second and two a third operation. The most common reason for reoperation was periprosthetic regurgitation without infection (N = 19). Four operations were performed for recurrent endocarditis. At 5 and 10 years, the risk of reoperation was 23% and 36%, respectively. Although surgical treatment of culture-positive active endocarditis is still associated with substantial mortality, the long-term outcome of hospital survivors is excellent. Subsequent reoperations for periprosthetic leak are common, but recurrent infection is uncommon.
AB - To describe a 30-year experience with surgically treated culture-positive active endocarditis. We retrospectively reviewed the microbiologic, clinical, and operative findings and the survival data in 151 patients with culture-positive active endocarditis encountered between 1961 and 1991. The mean age of the 110 male and 41 female patients was 49.8 years. Native valve endocarditis was present in 86 patients, and prosthetic valve endocarditis (PVE) was diagnosed in 65. The aortic valve was involved in 62 % of patients, the mitral valve in 25%, and both valves in 10%. The operative mortality was 26%. The most important univariate determinants of mortality were an abscess at operation (P = 0.01) and renal failure (P = 0.03). A trend toward a higher mortality with PVE and staphylococcal infection was noted. For hospital survivors, the 5- and 10-year survival was 71 % and 60%, respectively. Univariate determinants of an adverse longterm survival were annular abscess (P = 0.01), renal impairment (P = 0.01), heart failure (P = 0.02), and aortic valve involvement (P = 0.05). On multivariate analysis, the most important adverse determinants of long-term survival were heart failure (P = 0.02), renal impairment (P = 0.02), and PVE (P = 0.03). Thirty patients required a subsequent reoperation; of these, seven required a second and two a third operation. The most common reason for reoperation was periprosthetic regurgitation without infection (N = 19). Four operations were performed for recurrent endocarditis. At 5 and 10 years, the risk of reoperation was 23% and 36%, respectively. Although surgical treatment of culture-positive active endocarditis is still associated with substantial mortality, the long-term outcome of hospital survivors is excellent. Subsequent reoperations for periprosthetic leak are common, but recurrent infection is uncommon.
KW - AVR
KW - MVR
KW - NVE
KW - NYHA
KW - New York Heart Association
KW - PVE
KW - aortic valve replacement
KW - mitral valve replacement
KW - native valve endocarditis
KW - prosthetic valve endocarditis
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U2 - 10.4065/70.6.517
DO - 10.4065/70.6.517
M3 - Article
C2 - 7776709
AN - SCOPUS:0029078186
SN - 0025-6196
VL - 70
SP - 517
EP - 525
JO - Mayo Clinic proceedings
JF - Mayo Clinic proceedings
IS - 6
ER -