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Surgical Treatment of Infective Endocarditis: A Continued Challenge
G. Gavra, T. E. David, C. M. Feindel, S. Armstrong, M. Maganti, T. Regesta. Toronto General Hospital, Toronto, ON, Canada,
BACKGROUND: To examine the outcomes of surgery for active infective endocarditis (AIE) in a large cohort of patients.
METHODS: 418 patients were operated on for AIE. Their mean age was 52±16 years; 274 were men; 162 had isolated aortic valve (AV), 115 had isolated mitral valve (MV), 11 had isolated tricuspid valve, 2 had isolated pulmonary, and 128 had multiple valve AIE. The infected valve was prosthetic in 131 patients. Paravalvular abscess was present in 150. Aortic valve homograft was used in 18/280 patients who had aortic valve replacement, but the approach of radical resection of all infected tissues and reconstruction with patches were used in all patients. The mean follow-up was 6.1±5.2 years and was 98% complete.
RESULTS: There were 48 operative and 95 late deaths. Preoperative shock (odds ratio, OR= 5.2), paravalvular abscess (OR=3.2), prosthetic valve AIE (OR=3.1), renal failure (OR=2.9), and Staphylococcus aureus endocarditis (OR=1.9) were independent predictors of operative death. Paravalvular abscess (OR=2.5), prosthetic valve AIE (OR=1.9), and age (OR=1.7) were predictors of late death. The table below shows the longitudinal outcomes as estimated by the Kaplan-Meier method.| Event | 1-year | 5-year | 10-year | 15-year | | Survival | 85±2% | 74±3% | 63±4% | 45±6% | | Freedom from reoperation | 99±1% | 97±2% | 91±3% | 71±7% | | Freedom from endocarditis | 97±1% | 93±2% | 88±3% | 86±4% | | Freedom from paravalvular leak | 99±1% | 98±1% | 96±2% | 92±4% |
CONCLUSIONS: Conventional valve surgery for patients with infection limited to the valve and radical resection of paravalvular abscess results in cure in most patients but it is associated with high operative mortality.
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