TY - JOUR
T1 - Outcomes of surgery for infective endocarditis
T2 - A single-centre experience of 801 patients
AU - Said, Sameh M.
AU - Abdelsattar, Zaid M.
AU - Schaff, Hartzell V.
AU - Greason, Kevin L.
AU - Daly, Richard C.
AU - Pochettino, Alberto
AU - Joyce, Lyle D.
AU - Dearani, Joseph A.
N1 - Publisher Copyright:
© The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
PY - 2018/2/1
Y1 - 2018/2/1
N2 - OBJECTIVES: Infective endocarditis (IE) remains a life-threatening disease, despite the improvement in diagnostic and therapeutic measures. We reviewed our outcomes for all adults who underwent surgery for endocarditis at our centre. METHODS: Between January 1995 and December 2013, 801 patients [586 men (73%)] underwent surgery for IE. Mean age was 60 ± 14.7 years. Native endocarditis (NE) was present in 372 patients (46%), and 379 (47%) patients had active IE. The mean follow-up period was 4.6 4.75 years (maximum 20 years). RESULTS: Single-valve endocarditis was present in 551 (69%) patients (392 aortic and 159 mitral). Multivalve involvement was present in 250 (31%) patients. Preoperative stroke was present in 149 (19%) patients, while 62 (8%) patients were on dialysis prior to surgery. Valve repair was possible in 122 (15%) patients, while 679 (85%) patients underwent valve replacement. Mechanical valves were used in 312 (39%) patients. Aortic homografts were used in 84 (10%) patients. Earlymortality occurred in 64 (8%) patients. Overall survival at 5, 10 and 20 years was 68%, 45% and 8.4%, respectively. Postoperative stroke occurred in 16 (2%) patients, while 59 (7%) patients required new dialysis postoperatively. Multivariate analysis revealed active IE (P = 0.002), preoperative dialysis (P= 0.007), previous coronary artery bypass grafting (P= 0.001), root abscess (P= 0.006) and tricuspid valve or multivalve involvement (P = 0.002) to be predictors of early mortality. The need for dialysis (P < 0.001), previous coronary artery bypass grafting (P < 0.001) andmitral valve (P= 0.002) and tricuspid valve/multivalve involvement (P < 0.001) were significant predictors of latemortality. CONCLUSIONS: Active IE is associated with high perioperative mortality especially with multivalve and aortic root involvement. Preoperative stroke has no impact on perioperative mortality. Long-term survival for those who survived the immediate postoperative period is satisfactory, and mechanical valves are associated with the best long-term survival.
AB - OBJECTIVES: Infective endocarditis (IE) remains a life-threatening disease, despite the improvement in diagnostic and therapeutic measures. We reviewed our outcomes for all adults who underwent surgery for endocarditis at our centre. METHODS: Between January 1995 and December 2013, 801 patients [586 men (73%)] underwent surgery for IE. Mean age was 60 ± 14.7 years. Native endocarditis (NE) was present in 372 patients (46%), and 379 (47%) patients had active IE. The mean follow-up period was 4.6 4.75 years (maximum 20 years). RESULTS: Single-valve endocarditis was present in 551 (69%) patients (392 aortic and 159 mitral). Multivalve involvement was present in 250 (31%) patients. Preoperative stroke was present in 149 (19%) patients, while 62 (8%) patients were on dialysis prior to surgery. Valve repair was possible in 122 (15%) patients, while 679 (85%) patients underwent valve replacement. Mechanical valves were used in 312 (39%) patients. Aortic homografts were used in 84 (10%) patients. Earlymortality occurred in 64 (8%) patients. Overall survival at 5, 10 and 20 years was 68%, 45% and 8.4%, respectively. Postoperative stroke occurred in 16 (2%) patients, while 59 (7%) patients required new dialysis postoperatively. Multivariate analysis revealed active IE (P = 0.002), preoperative dialysis (P= 0.007), previous coronary artery bypass grafting (P= 0.001), root abscess (P= 0.006) and tricuspid valve or multivalve involvement (P = 0.002) to be predictors of early mortality. The need for dialysis (P < 0.001), previous coronary artery bypass grafting (P < 0.001) andmitral valve (P= 0.002) and tricuspid valve/multivalve involvement (P < 0.001) were significant predictors of latemortality. CONCLUSIONS: Active IE is associated with high perioperative mortality especially with multivalve and aortic root involvement. Preoperative stroke has no impact on perioperative mortality. Long-term survival for those who survived the immediate postoperative period is satisfactory, and mechanical valves are associated with the best long-term survival.
KW - Active endocarditis
KW - Healed endocarditis
KW - Native endocarditis
KW - Prosthetic endocarditis
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U2 - 10.1093/ejcts/ezx341
DO - 10.1093/ejcts/ezx341
M3 - Article
C2 - 29029030
AN - SCOPUS:85041514187
SN - 1010-7940
VL - 53
SP - 435
EP - 439
JO - European Journal of Cardio-Thoracic Surgery
JF - European Journal of Cardio-Thoracic Surgery
IS - 2
M1 - ezx341
ER -