Early and late survival after surgical treatment of culture-positive active endocarditis

C. J. Mullany, Y. L. Chua, Hartzell V Schaff, J. M. Steckelberg, D. M. Ilstrup, T. A. Orszulak, G. K. Danielson, F. J. Puga

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Abstract

Objective: To describe a 30-year experience with surgically treated culture-positive active endocarditis. Design: 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. Results: 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. Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)517-525
Number of pages9
JournalMayo Clinic Proceedings
Volume70
Issue number6
StatePublished - 1995

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Endocarditis
Survival
Reoperation
Mortality
Therapeutics
Aortic Valve
Abscess
Survivors
Heart Failure
Kidney
Staphylococcal Infections
Infection
Mitral Valve
Renal Insufficiency
Multivariate Analysis

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Mullany, C. J., Chua, Y. L., Schaff, H. V., Steckelberg, J. M., Ilstrup, D. M., Orszulak, T. A., ... Puga, F. J. (1995). Early and late survival after surgical treatment of culture-positive active endocarditis. Mayo Clinic Proceedings, 70(6), 517-525.

Early and late survival after surgical treatment of culture-positive active endocarditis. / Mullany, C. J.; Chua, Y. L.; Schaff, Hartzell V; Steckelberg, J. M.; Ilstrup, D. M.; Orszulak, T. A.; Danielson, G. K.; Puga, F. J.

In: Mayo Clinic Proceedings, Vol. 70, No. 6, 1995, p. 517-525.

Research output: Contribution to journalArticle

Mullany, CJ, Chua, YL, Schaff, HV, Steckelberg, JM, Ilstrup, DM, Orszulak, TA, Danielson, GK & Puga, FJ 1995, 'Early and late survival after surgical treatment of culture-positive active endocarditis', Mayo Clinic Proceedings, vol. 70, no. 6, pp. 517-525.
Mullany CJ, Chua YL, Schaff HV, Steckelberg JM, Ilstrup DM, Orszulak TA et al. Early and late survival after surgical treatment of culture-positive active endocarditis. Mayo Clinic Proceedings. 1995;70(6):517-525.
Mullany, C. J. ; Chua, Y. L. ; Schaff, Hartzell V ; Steckelberg, J. M. ; Ilstrup, D. M. ; Orszulak, T. A. ; Danielson, G. K. ; Puga, F. J. / Early and late survival after surgical treatment of culture-positive active endocarditis. In: Mayo Clinic Proceedings. 1995 ; Vol. 70, No. 6. pp. 517-525.
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abstract = "Objective: To describe a 30-year experience with surgically treated culture-positive active endocarditis. Design: 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. Results: 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. Conclusion: 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.",
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T1 - Early and late survival after surgical treatment of culture-positive active endocarditis

AU - Mullany, C. J.

AU - Chua, Y. L.

AU - Schaff, Hartzell V

AU - Steckelberg, J. M.

AU - Ilstrup, D. M.

AU - Orszulak, T. A.

AU - Danielson, G. K.

AU - Puga, F. J.

PY - 1995

Y1 - 1995

N2 - Objective: To describe a 30-year experience with surgically treated culture-positive active endocarditis. Design: 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. Results: 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. Conclusion: 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 - Objective: To describe a 30-year experience with surgically treated culture-positive active endocarditis. Design: 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. Results: 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. Conclusion: 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.

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