Outcomes of surgery for infective endocarditis

A single-centre experience of 801 patients

Sameh M. Said, Zaid M. Abdelsattar, Hartzell V Schaff, Kevin L. Greason, Richard C. Daly, Alberto Pochettino, Lyle D. Joyce, Joseph A. Dearani

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Article numberezx341
Pages (from-to)435-439
Number of pages5
JournalEuropean Journal of Cardio-thoracic Surgery
Volume53
Issue number2
DOIs
StatePublished - Feb 1 2018

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Endocarditis
Dialysis
Tricuspid Valve
Stroke
Coronary Artery Bypass
Survival
Mortality
Postoperative Period
Abscess
Allografts
Multivariate Analysis

Keywords

  • Active endocarditis
  • Healed endocarditis
  • Native endocarditis
  • Prosthetic endocarditis

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Said, S. M., Abdelsattar, Z. M., Schaff, H. V., Greason, K. L., Daly, R. C., Pochettino, A., ... Dearani, J. A. (2018). Outcomes of surgery for infective endocarditis: A single-centre experience of 801 patients. European Journal of Cardio-thoracic Surgery, 53(2), 435-439. [ezx341]. https://doi.org/10.1093/ejcts/ezx341

Outcomes of surgery for infective endocarditis : A single-centre experience of 801 patients. / Said, Sameh M.; Abdelsattar, Zaid M.; Schaff, Hartzell V; Greason, Kevin L.; Daly, Richard C.; Pochettino, Alberto; Joyce, Lyle D.; Dearani, Joseph A.

In: European Journal of Cardio-thoracic Surgery, Vol. 53, No. 2, ezx341, 01.02.2018, p. 435-439.

Research output: Contribution to journalArticle

Said, SM, Abdelsattar, ZM, Schaff, HV, Greason, KL, Daly, RC, Pochettino, A, Joyce, LD & Dearani, JA 2018, 'Outcomes of surgery for infective endocarditis: A single-centre experience of 801 patients', European Journal of Cardio-thoracic Surgery, vol. 53, no. 2, ezx341, pp. 435-439. https://doi.org/10.1093/ejcts/ezx341
Said, Sameh M. ; Abdelsattar, Zaid M. ; Schaff, Hartzell V ; Greason, Kevin L. ; Daly, Richard C. ; Pochettino, Alberto ; Joyce, Lyle D. ; Dearani, Joseph A. / Outcomes of surgery for infective endocarditis : A single-centre experience of 801 patients. In: European Journal of Cardio-thoracic Surgery. 2018 ; Vol. 53, No. 2. pp. 435-439.
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abstract = "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.",
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AU - Greason, Kevin L.

AU - Daly, Richard C.

AU - Pochettino, Alberto

AU - Joyce, Lyle D.

AU - Dearani, Joseph A.

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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

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KW - Prosthetic endocarditis

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