Cor Vasa 2010, 52(5-6):332-339 | DOI: 10.33678/cor.2010.085

Results of surgical treatment of infective endocarditis

Branislav Laca^1,*, Jana Páleníčková², Sláva Kučerová¹, Marek Šetina¹

¹ Kardiochirurgická klinika pro dospělé, Kardiovaskulární centrum, Fakultní nemocnice Motol a 2. lékařská fakulta Univerzity Karlovy

² Kardiologické oddělení pro dospělé, Kardiovaskulární centrum, Fakultní nemocnice Motol, Praha, Česká republika

Aim of the study: To evaluate short-term and long-term results of surgical treatment of infective endocarditis (IE) in patients operated on in our department.

Methods: From 1994 to 2007, 63 patients with the diagnosis of infective endocarditis underwent operation in Motol University Hospital. Native valve endocarditis was present in 54 cases (85.7%) and prosthetic endocarditis in 9 (14.3%). Sixteen patients (25.4%) had a history of intravenous (i.v.) drug abuse. We conducted a retrospective analysis of this cohort to assess their long-term survival and reoperation and reinfection rates. At follow-up, the clinical status of patients and function of the operated valves were evaluated. Mean follow-up period was 49.6 ± 46 months.

Results: Overall in hospital mortality was 20.6% (13/63). In the period of 1994-2001, mortality was 29.2% (7/24) whereas, in 2002-2007, it was 15.4% (6/39). Significantly higher mortality was found in patients with periannular abscess (6/14; 42.9%; p = 0.02). On the contrary, i.v. drug users (1/16; 6.3%; p = 0.04) had significantly lower mortality rates. A high mortality rate was also seen in patients with prosthetic valve endocarditis (3/9; 33.3%). Mortality was affected neither by location of IE nor the type of surgical procedure performed. Ten year survival was 65.1% (41/63). Reoperation was necessary in 7 patients (11.1%), in 2 (3.2%) due to reinfection and, in 5 (7.9%) due to valve dysfunction. I.v. drug addicts were reoperated more often (3/16; 18.8%). Infective endocarditis recurred in 4 patients (6.3%). A significantly higher incidence was seen in the i.v. drug user group (3/16; 18.8%; p = 0.017). Most of the reoperations (6/7) and all reinfections occurred within two years of operation. At follow-up, significant valve dysfunction was observed in 3 patients (9.4%), average NYHA class was 1,7 ± 0,6.

Conclusion: Our results of surgical treatment of IE confirm that in-hospital mortality remains high, especially in patients with periannular abscess and prosthetic valve endocarditis. Risk of complications in terms of reinfection and reoperation is highest in the first two postoperative years, mainly in i.v. drug users. Follow-up showed a good clinical status of patients, very good function of the operated valves and satisfactory long-term prognosis.

Keywords: Infective endocarditis; Surgical treatment; Reinfection; Reoperation

Published: May 1, 2010  Show citation