Document Detail


Surgical treatment of active infective endocarditis: a continued challenge.
MedLine Citation:
PMID:  17198801     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: This study was undertaken to examine the outcomes of surgery for active infective endocarditis in a large cohort of patients. METHODS: Three hundred eighty-three consecutive patients underwent surgery for active infective endocarditis. The mean age was 51 +/- 16 years, and 64% were men. The infected valve was native in 266 patients and prosthetic in 117. Staphylococcus aureus was the most common microorganism. Surgery consisted of valve replacement or repair in patients with infection limited to the cusps or leaflets of the valve or radical resection of seemingly infected paravalvular tissues, and reconstruction with patches and valve replacement in patients with abscess (135 patients). The mean follow-up was 6.1 +/- 5.2 years. RESULTS: There were 45 (12%) operative and 88 (23%) late deaths. The operative mortality did not change during the period of study. Preoperative shock, prosthetic valve endocarditis, paravalvular abscess, and S aureus were independent predictors of operative mortality. Age, shock, prosthetic valve endocarditis, left ventricular ejection fraction less than 40%, and recurrent endocarditis were independent predictors of death from all causes. Survivals at 15 years were 44% +/- 5% overall, 59% +/- 5% for native valve endocarditis, and 25% +/- 7% for prosthetic valve endocarditis (P = .001). Freedom from recurrent endocarditis at 15 years was 86% +/- 3% for all patients, similar to those for native and prosthetic valve endocarditis (P = .39). Freedom from reoperation at 15 years was 70% +/- 6% for all patients, similar to those for native and prosthetic valve endocarditis (P = .55). CONCLUSIONS: Surgery for endocarditis continues to be challenging and associated with high operative mortality and morbidity. Age, shock, prosthetic valve endocarditis, impaired ventricular function, and recurrent infections adversely affect long-term survival.
Authors:
Tirone E David; Gheorghe Gavra; Christopher M Feindel; Tommaso Regesta; Susan Armstrong; Manjula D Maganti
Publication Detail:
Type:  Journal Article     Date:  2006-11-30
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  133     ISSN:  1097-685X     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2007 Jan 
Date Detail:
Created Date:  2007-01-02     Completed Date:  2007-01-30     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  144-9     Citation Subset:  AIM; IM    
Affiliation:
Division of Cardiovascular Surgery of Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada. tirone.david@uhn.on.ca
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MeSH Terms
Descriptor/Qualifier:
Cardiac Surgical Procedures / mortality
Endocarditis, Bacterial / microbiology,  mortality,  surgery*
Female
Heart Valve Prosthesis Implantation* / adverse effects
Heart Valves / surgery*
Humans
Male
Middle Aged
Prosthesis-Related Infections / surgery
Recurrence
Staphylococcal Infections / surgery
Survival Rate

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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