January 1, 1997European Journal of Cardio-Thoracic Surgery
Long-term results of surgery for active infective endocarditis1
Population
122 consecutive patients operated on during the acute phase of infective endocarditis. Complications…
Design
Cohort
Follow-up
mean 56.4 months (range 4 to 173 months)
Authors
Discussion
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Implication
May support surgery for active IE; extends observational data but leaves open need for randomized trials on timing and selection.
Key Points
- Determine the long-term survival and clinical outcomes of patients with active infective endocarditis treated with antimicrobial therapy and radical surgical excision.
- Analyzed 122 consecutive patients (mean age 50 years; 76 native valve, 46 prosthetic valve) operated on during acute infective endocarditis between October 1978 and August 1994.
- Surgical interventions comprised simple valve repair or replacement (n=60) or radical resection and reconstruction using autologous or bovine pericardium for paravalvular abscess (n=62).
- Evaluated operative mortality and long-term outcomes with logistic regression over a mean follow-up of 56.4 months (range 4 to 173 months).
- Operative mortality was 7.4% (9 deaths), with preoperative shock and renal failure identified as predictors of early death by logistic regression.
- The actuarial survival at 10 years was 61 ± 6%, with preoperative NYHA class IV status and perioperative renal failure predicting late mortality.
- Freedom from recurrent endocarditis at 10 years was 79 ± 9% (n=8 recurrences), with paravalvular abscess present at the initial operation in all recurrent cases.
Structured PICO
P
Population
122 consecutive patients operated on during the acute phase of infective endocarditis (85 men, 37 women, mean age 50 years). Complications included cardiogenic/septic shock (n=19), congestive heart failure (n=68), persistent sepsis (n=64), peripheral embolization (n=20), and cerebral embolization (n=10). 76 had native valve endocarditis and 46 had prosthetic valve endocarditis.
I
Intervention
Surgery (antibiotic and radical excision of infected tissues, including simple valve replacement/repair or radical resection with reconstruction)
O
Outcome
Operative mortality and long-term survival (actuarial survival at 10 years)hard clinical
Surgery for active infective endocarditis provides a high probability of eradicating the infection with relatively low operative mortality and good long-term survival.
Cite This Study
d’Udekem et al. (1997) studied this question.