人工心脏瓣膜心内膜炎的外科治疗

目的 总结人工心脏瓣膜心内膜炎(PVE)的外科治疗。方法 1990年至2003年8月，手术治疗PVE病人21例，其中亚急性16例，急性5例。血细菌培养阳性13例。心脏超声检查主动脉瓣瓣周漏6例，二尖瓣瓣周漏3例，主动脉瓣区赘生物3例，二尖瓣区5例。应用机械瓣再次手术行二尖瓣置换11例，主动脉瓣置换10例，同期行升主动脉假性瘤切除和主动脉修补成形1例。术中均见有赘生物；二尖瓣环脓肿7例，瓣周脓肿3例；主动脉瓣环脓肿8例，瓣周脓肿4例。结果术后早期死亡5例，其中3例死于感染复发，2例死于多脏器功能衰竭；晚期死亡1例。随访4个月至13年，1例PVE再发，内科治疗无效，死亡。结论及时诊断PVE，正确掌握手术时机，彻底清除感染组织和围术期应用大剂量敏感抗生素，是提高PVE手术效果的关键。     

严重主动脉瓣感染性心内膜炎患者主动脉根部置换的方法与疗效

目的总结严重主动脉瓣感染性心内膜炎患者行主动脉根部置换术治疗的临床经验,探讨其手术适应证和手术方法,以期提高外科治疗效果。方法1995年9月～2008年6月间手术治疗11例严重主动脉瓣或人工瓣膜感染性心内膜炎患者,其中活动期6例,静止期5例;术前动脉血细菌培养阳性6例。术前心脏超声心动图提示均有不同程度的主动脉瓣反流或瓣周漏,左心室收缩期末内径（LVESD）6．0±0．7cm,其中≥5．5cm 7例;左心室射血分数（LVEF）47．8％±11．2％,其中≤509／8例。手术均在彻底清创后应用人工带瓣管道（9例）或同种带瓣管道（2例）行主动脉根部置换术,同期行冠状动脉旁路移植术4例,二尖瓣环缩术3例,室间隔缺损修补术1例。结果术后心脏骤停死亡1例。发生Ⅲ°房室传导阻滞1例,后期植入永久性起搏器。术后随访10例,随访时间3个月～13．2年,术后32d因感染性心内膜炎复发死亡1例;其余患者均无感染复发和晚期死亡。结论当感染性心内膜炎合并主动脉根部或窦部瘤、感染累及主动脉窦壁或冠状动脉开口处、瓣环严重毁损或彻底清创后瓣环缺损广泛时,宜置换主动脉根部。手术的关键是彻底清创和防止根部出血。尽管手术较复杂,但局部清创彻底,有利于提高手术效果。     

三瓣膜替换术中自体心包片加宽升主动脉及其瓣环2例

三瓣膜替换术中自体心包片加宽升主动脉及其瓣环２例王奇，朱朗标１９９２年２月和１９９４年５月，我们为２例风湿性心脏病联合瓣膜病变病人行二尖瓣、主动脉瓣及三尖瓣三瓣膜替换术的同时，用自体心包片加宽升主动脉及主动脉瓣环，取得良好效果。现报告如下：临床资料２...     

儿童感染性心内膜炎的外科治疗

目的：总结儿童感染性心内膜炎的外科治疗经验，以期掌握好手术时机及指征，提高手术成功率。方法：28例儿童心内膜炎病人，7例因急性心力衰竭、栓塞或严重败血症急诊手术；21例经抗生素治疗体温正常后择期手术。彻底清除赘生物后，同时行主动脉瓣瓣膜置换5例，主动脉根部拓宽、主动脉瓣瓣膜置换2例，室间隔缺损（室缺）修补5例，室缺修补、右室流出道疏通2例，室缺和佛氏窦瘤修补2例，室缺修补、主动脉瓣瓣膜置换2例，动脉导管缝扎3例，动脉导管缝扎、主动脉瓣瓣膜置换1例，二尖瓣瓣膜置换3例，二尖瓣瓣膜置换、左冠前降支取栓并搭桥1例，法洛四联症矫正、Rastelli手术和1例。同期行三尖瓣成形6例、肺动脉瓣成形7例。结果：手术死亡1例（3．6％），死亡原因为术后霉菌性感染不能控制、多器官功能衰竭。术后平均随访2．6年，心内膜炎复发2例，无远期死亡。结论：儿童感染性心内膜炎手术治疗的远期效果满意，其手术时机及指征的掌握对治疗效果至关重要。     

Manouguian法瓣环增宽加主动脉瓣置换术治疗成人小主动脉瓣环

目的总结成人主动脉瓣狭窄伴小主动脉瓣环行瓣环增宽并替换主动脉瓣的经验。方法 12例病人行主动脉瓣环增宽并替换主动脉瓣。手术径路均采用Manouguian法：将主动脉斜切口下延伸,经无冠瓣与左冠瓣交界处向下,垂直切开瓣环至二尖瓣基部。采用绦纶片内衬自体心包片作为增宽材料,替换23 mm或25 mm主动脉瓣;同期行二尖瓣替换4例。结果 1例同期行二尖瓣置换者因严重低心排死于手术当晚;1例术后第7 d因心包填塞经剑突下引流后痊愈;肺部感染并发呼吸功能不全1例,经气管切开及呼吸机支持1周后痊愈;1例主动脉根部明胶海绵物填充后感染于术后12 d再次开胸清除腐烂明胶海绵,并留管冲洗引流而愈。本组术后住院13~20 d,平均（16.2±1.5）d;11例患者均获随访,时间5~84个月,平均（36.7±21.2）个月,心功能恢复至Ⅰ级5例,Ⅱ级6例,无远期死亡。结论对大多数小主动脉瓣环,采用Manouguian术式简单易行,不需切开二尖瓣基部,已能满足替换23 mm或25 mm瓣膜,增宽材料易得,效果可靠。     

感染性心内膜炎伴瓣膜病变的外科治疗

自１９８９年９月～１９９３年７月对２０例感染性心内膜炎伴瓣膜病变病人施行瓣膜替换术，其中主动瓣替换术８例二尖瓣替换术６例，双瓣替换术６例，无手术死亡，随访３～３８个月疗效满意，作者认为瓣膜替换术对治疗感染性心内膜炎心瓣膜失功者，是一种有挽救生命方法，并对手术时机的选择及术前后抗生素应用进行讨论。     

瓣环扩大术在小主动脉瓣环中的应用

目的探讨小主动脉瓣环病变患者行瓣环扩大后置换主动脉瓣的临床效果。方法对22例小主动脉瓣环病变患者在主动脉瓣置换时进行瓣环扩大术,采用Manougnian法主动脉根部成形术13例,Nicks法9例;同期施行二尖瓣置换术4例,室间隔缺损修补术2例。术后3、6和12个月时行超声心动图检查,并进行随访。结果全组无手术死亡患者,无出血并发症发生,均痊愈出院。术后3、6和12个月时跨瓣压差分别为10.2±2.1 mmHg(1kPa=7.5mmHg)、10.2±2.3 mmHg和9.8±3.1 mmHg,射血分数分别为0.66±0.02、0.68±0.09和0.68±1.20;左心室短轴缩短率为0.42±0.06、0.48±0.08和0.51±0.07,心室间隔厚度/左室后壁厚度为1.08±0.06、1.16±0.04和1.21±0.18。随访13年,机械瓣活动良好,心功能(NYHA)I级18例,Ⅱ级4例。结论小主动脉瓣环患者行心瓣膜置换时同期行瓣环扩大术是一种安全有效的术式,近、远期效果良好。     

瓣环结构重建的瓣膜置换手术

目的 总结瓣环结构重建的瓣膜置换手术技术及临床效果.方法 2003年1月至2009年5月59例病人行瓣环结构重建的瓣膜置换手术,其中细小主动脉根部43例,感染性心内膜炎累及瓣环结构13例,钙化性主动脉瓣病变钙化斑累及主动脉瓣环2例,主动脉瓣二尖瓣置换手术后主动脉根部出血1例.行主动脉瓣环重建加主动脉瓣置换术40例,二尖瓣瓣环重建二尖瓣置换术7例,主动脉-二尖瓣纤维环重建加主动脉二尖瓣置换术12例.结果 二尖瓣瓣环重建加二尖瓣置换手术与常规二尖瓣置换手术的主动脉阻断时间差异无统计学意义;而主动脉瓣瓣环重建加主动脉瓣置换以及二尖瓣-主动脉瓣纤维连接重建加二尖瓣主动脉瓣置换手术的主动脉阻断时间均明显延长.本组术后早期死亡4例,占6.7%.术后再次开胸止血2例,Ⅲ度房室传导阻滞2例,呼吸功能不全2例,急性肾功能衰竭2例.术后6个月复查超声心动图,无瓣周漏.结论 瓣环结构重建手术适合于瓣环过小需置人与体表面积相匹配的人工瓣膜、瓣膜病变累及瓣环结构的完整性或手术损伤等情况,尽管其手术操作较为复杂,主动脉阻断和体外循环时问均有所延长,但手术操作引起死亡的比率并未增加.

Abstract：

Objective To investigate the surgical technique and clinical outcomes of reconstruction of the annulus and the intervalvular fibrous body during valve replacements. Methods Fifty-nine patients underwent reconstruction of the annulus or the intervalvular fibrous body during the valve replacement. Indications for the operation were small aortic annulus which may cause patient/prosthesis mismatch in 43, active infective endocarditis with the abscess in the periannulus tissue in 13, extensive calcification of the aortic annulus in 2 and an active bleeding complication of the aortic root after aortic and mitral valve replacement in 1. The reconstruction was done with fresh autologous pericardium. Results The aortic clamping time in reconstruction of the intervalvular fibrous body with double valve replacement was longer than that of the regular double valve replacement. Four patients died in the perioperative period, giving an overall in- hospital mortality of 6.7%. Postoperative complication were: re-sternotomy for bleeding in 2, Ⅲ degree A-V block in 2, respiratory dysfunction in 2, and acute renal failure in 2. Patients were followed up for 6 months by echocardiography study, and no periannular leakage was found. Conclusion Reconstruction of the annulus is an effective technique for patients with a small aortic annulus, extensive calcification of the interventricular fibrous body and active infective endocarditis with abscess. Although the operative procedure is challenging and taking more time, the technique is safe and reproducible.     

合并巨大左心室的心脏瓣膜替换术

目的:评价合并巨大左心室心脏瓣膜替换术的疗效。方法:从2000年9月至2002年10月,共13例合并巨大左心室的心脏瓣膜病行人工瓣膜替换术,其中主动脉瓣置换术9例,二尖瓣置换术1例,主动脉瓣置换术+二尖瓣置换术3例,二尖瓣置换术均保留二尖瓣后瓣及瓣下结构,三尖瓣成形术1例,左心房血栓清除术1例,主动脉窦瘤修补术2例,室间隔缺损修补术2例。结果:术后无死亡,无严重低心排、严重室性心律失常和多器官功能衰竭,并发肾功能不全1例,术后并发大量心包积液,行二次心包开窗引流术1例,13例均康复出院。结论:提高这类病人手术疗效的关键是选择合适的时机、妥善的围术期处理。     

Ross 手术治疗先天性主动脉瓣膜疾病

目的　总结 Ross手术治疗先天性主动脉瓣膜疾病的临床经验和手术结果。　方法　自 1998年 3月至2 0 0 2年 7月 ,16例主动脉瓣膜疾病患者 (平均年龄 14 .0± 9.9岁 )接受 Ross手术 ,即自体肺动脉瓣移植术。诊断为主动脉瓣二瓣化畸形 ,主动脉瓣狭窄 9例 ,主动脉瓣发育不良呈穹隆状狭窄 2例 ;主动脉瓣脱垂 5例 ,其中合并室间隔缺损和动脉导管未闭各 1例。　结果　无手术死亡 ,全部患者治愈出院。随访 1～ 4 8个月 ,平均 30± 13个月 ,无远期死亡 ,无瓣膜相关并发症。所有患者心功能 级。超声心动图提示主动脉瓣及同种肺动脉瓣功能良好 ,仅 1例患者主动脉瓣有极少量反流 ;所有患者主动脉瓣跨瓣压差 2 .1± 0 .8mm Hg(1k Pa=7.5 mm Hg) ,左心室流出道及主动脉瓣环随着年龄的生长而增长 ,平均瓣环直径较术后增加 4 .0± 2 .1mm。　结论　 Ross手术治疗主动脉瓣膜疾病安全 ,效果好 ,随机体发育而生长 ,可适于某些主动脉瓣瓣膜疾病 ,尤其适于小儿及年轻患者。     

原发性感染性心内膜炎的外科治疗（附102例报告）

回顾性分析原发性感染性心内膜炎１０２例，其中主动脉瓣病变７１例，二尖瓣病变１６例，主动脉瓣与二尖瓣联合病变６例，三尖瓣病变５例，肺动脉瓣病变４例。按照病人术前心功能状态，分为：（１）急性心功能不全组（２５例）；（２）慢性心功能不全组（７７例）。施行主动脉瓣替换术７１例，二尖瓣替换术１６例，双瓣替换术６例，三尖瓣修复成形术５例，肺动脉瓣成形术４例。术后早期死亡９例（８．８％）。９３例生存者随访时间３个月～１６年，平均随访时间４．３年。晚期死亡６例，其中２例为人工瓣膜心内膜炎，复发率为２％。作者对手术时机与手术方式的选择作了讨论，并介绍了围术期处理的经验。     

Surgical treatment of paravalvular abscess: long-term results.

OBJECTIVE: To examine the outcomes of surgery for active infective endocarditis with paravalvular abscess. METHODS: Paravalvular abscess was defined as infective necrosis of the valve annulus that required patch reconstruction before implanting a new valve. Of 383 patients with active infective endocarditis who underwent surgical treatment, 135 (35%) had paravalvular abscess. Patients' mean age was 51+/-16 years and 68% were men. The infected valve was native in 69 patients and prosthetic in 66. The abscess involved the aortic annulus in 73 patients, the mitral annulus in 27, the aortic and mitral annuluses in 33, and the aortic and tricuspid and/or pulmonary annuluses in 2. Surgery consisted of radical resection of the abscess, reconstruction of the annulus with patches and valve replacement. Mean follow-up was 6.2+/-5.2 years and complete. RESULTS: There were 21 (15.5%) operative deaths. Preoperative shock and abscess in the aortic and mitral annuluses were independent predictors of operative death. There were 34 (25%) late deaths. Survival at 15 years was 43+/-6% for all patients, 50+/-8% for native valve endocarditis and 35+/-9% for prosthetic (p=0.41). Age by increments of 5 years and recurrent endocarditis were independent predictors of late death. There were 16 episodes of recurrent endocarditis in 15 patients, and the freedom from recurrent endocarditis was 82+/-4% at 15 years. Fifteen reoperations were performed in 14 patients. Freedom from reoperation was 72+/-9% at 15 years. CONCLUSIONS: Surgery for active endocarditis with paravalvular abscess was associated with high operative mortality, particularly in patients in shock and abscess of both mitral and aortic annuluses. Long-term survival was adversely affected by age and recurrent bouts of endocarditis.     

Surgical outcomes of mitral valve replacement with concomitant mitral annular reconstruction

Background and aim of the study

We evaluated the early and long‐term outcomes of mitral annular reconstruction (MAR) with pericardium during mitral valve replacement (MVR), and analyzed the risk factors associated with post‐operative mortality.

Methods

Between May 1997 and April 2013, 78 consecutive patients underwent MVR with MAR. The indications for MAR were treatment for annular infection in native valve endocarditis (n = 23, 29.5%) or prosthetic valve endocarditis (n = 26, 33.3%), reinforcement of damaged annulus resulting from a previous operation (n = 17, 21.8%), complete excision of extensive calcification (n = 9, 11.5%), and left ventricular or left atrial rupture (n = 3, 3.8%). Patients were classified into infective endocarditis (n = 49) and non‐endocarditis groups (n = 29). The mean follow‐up period was 59.4 ± 47.3 months.

Results

There were two operative deaths and 11 cases of late mortality in the endocarditis group and five cases in the non‐endocarditis group. Late prosthetic valve endocarditis occurred in four patients. The overall survival rate at 1 and 10 years was 94.8% and 65.1%, respectively. There was no statistical difference in the overall survival, freedom from reoperation, and freedom from endocarditis rates between the groups (P = 0.565, P = 0.635, and P = 0.449, respectively). Univariable and multivariable analyses revealed that pre‐operative left ventricular dysfunction (ejection fraction <40%) was an independent predictor of overall mortality.

Conclusions

The early and long‐term results of MAR with pericardium during MVR are acceptable in both endocarditis and non‐endocarditis patients.     

Annular reconstruction for mitral valve replacement in a destroyed or calcified mitral annulus

Mitral valve replacement in the presence of severe annular calcification and an infectious lesion may be complicated by atrioventricular rupture, left circumflex coronary artery injury, and recurrence of infective endocarditis. Confronted with these circumstances, we have developed a technique of annular reconstruction for mitral valve replacement. The prosthetic valve is made by enlarging the circumference of the sewing ring with a Dacron collar. The collar can be sutured to the left atrial wall above the mitral annulus. This technique has been employed in five patients: three had extensive annular calcification, and two had acute valve endocarditis with destruction of mitral annulus. In all cases, the circumferential or partial annular reconstruction permitted secure implantation of the prosthetic valve. The one postoperative death was related to hemodialysis due to chronic renal failure. There were no other fatalities during the postoperative course, and the valves functioned normally. Our results suggest that this technique can be performed in high operative risk patients when mitral valve replacement is impossible using conventional techniques.     

Acute endocarditis treated with radical debridement and implantation of mechanical or stented bioprosthetic devices

BACKGROUND: Operation for active infective endocarditis carries high mortality and morbidity rates, especially when the annulus is involved. Overall the literature favors the use of autograft and homograft valves because of better resistance to infection. In our clinic during the last 5 years we used an aggressive surgical approach to infective endocarditis in combination with implantation of mechanical or stented bioprosthetic devices. METHODS: From 1994 to 1999, 50 adults with aortic and/or mitral valve endocarditis underwent valve replacement. The median age of the 36 men and 14 women was 58 years (range, 17 to 78 years). All patients had active endocarditis at the time of operation. Native valve endocarditis was present in 48 patients and prosthetic valve endocarditis was present in 2 patients. The aortic valve was affected in 24 patients, the mitral valve in 21 patients, and both the aortic and mitral valves in 5 patients. Two of the patients with mitral endocarditis also had infection of the tricuspid valve. Annular destruction was present in 24 patients (48%). The patients were treated with radical excision of all infected tissue. The annular defects were closed, if possible, with direct sutures. Otherwise, a reconstruction was performed. Follow-up was 100% complete with a median follow-up period of 45 months (range, 6 to 66 months). RESULTS: The procedures were performed without lethal bleeding complications. Early mortality was 12% and the actuarial survival at follow-up was 80%. In none of the patients who died was death related to the prosthetic valve or recurrence of the endocarditis. Only 1 patient (2%) developed recurrence of the infective endocarditis and was reoperated with a Ross procedure. Three and a half years later the patient developed severe valve insufficiency of the autograft and was operated again with implantation of a mechanical device. CONCLUSIONS: Native and prosthetic valve endocarditis can be treated successfully with aggressive surgical debridement and implantation of mechanical or stented bioprosthetic devices with a low risk of recurrent endocarditis.     

Aortic and mitral valve replacement with reconstruction of the intervalvular fibrous body: an analysis of clinical outcomes

OBJECTIVE: This study was undertaken to evaluate the late outcomes of reconstruction of the intervalvular fibrous body during aortic and mitral valve replacement. METHODS: Seventy-six consecutive patients underwent reconstruction of the intervalvular fibrous body with replacement of the mitral and aortic valves. There were 35 men and 41 women whose mean age was 58 +/- 12 years. Additional procedures were circumferential reconstruction of the mitral annulus in 27 patients, tricuspid valve repair in 21, coronary artery bypass in 15, and aortic root replacement in 4. Indications for the operation were active infective endocarditis with abscess in 15 patients, extensive calcification of the mitral annulus and interventricular fibrous body in 24, lack of fibrous tissue to secure a prosthetic valve in 17, and treatment or prevention of patient-prosthesis mismatch in 20. Fifty-five patients had undergone one or more previous valve operations, and 52 (68%) were in functional class IV. The mean follow-up was 47 +/- 47 months, and it was complete. RESULTS: There were 8 (10%) operative and 18 (24%) late deaths. The 10-year survival was 50% +/- 9%. There were 15 reoperations in 12 patients: 7 for prosthetic valve endocarditis (5 early, 2 late), 7 for patch or valve dehiscence (3 early, 4 late), and 1 for structural valve deterioration. All but 2 reoperations were re-reconstruction of the intervalvular fibrous body and double valve replacement. The 10-year freedom from reoperation was 73% +/- 7%. CONCLUSION: Reconstruction of the intervalvular fibrous body during double valve replacement is a technically challenging operation, but it is useful in patients with complex valve pathology for whom no alternative procedure is available.     

Optimal size of prostheses for functioning of the aortic prosthetic valve in aortic and mitral valve replacement with annular enlargement through Manouguian's technique

There is not yet agreement about the optimal size of the prostheses in aortic and mitral valve replacement with Manouguian's technique. In this technique, the aortic prosthetic valve can be pushed upon the mitral prosthesis which may cause dysfunction of the aortic prosthetic valve. The aim of this study was to clarify the size of the prostheses needed to avoid dysfunction of the aortic prosthetic valve. Three patients underwent aortic and mitral valve replacement through this procedure. Two of them had active aortic and mitral valve endocarditis. Aortomitral continuity involved with abscesses could be approached and completely excised using this technique. All patients survived the operation, but 1 of them suffered aortic mechanical valve dysfunction for the reason stated. Anatomical analysis of the geometrical relation of the 2 prosthetic valves suggests that the mitral annulus should be enlarged less than 25 mm to avoid dysfunction of the aortic prosthetic valve.     

Heart valve operations in patients with active infective endocarditis

Sixty-two consecutive patients underwent heart valve operation for active infective endocarditis. There were 42 men and 20 women whose mean age was 49 years (range, 21 to 79 years). The infection was in the aortic valve in 37 patients, the mitral valve in 18, the aortic and mitral valves in 5, and the tricuspid valve in 2. Twenty-four patients had prosthetic valve endocarditis. Staphylococcus and Streptococcus were responsible for 86% of the infections. Annular abscess was encountered in 33 patients. Complex valve procedures involving reconstruction of the left ventricular inflow or outflow tract or both were performed in 31 patients. There were three operative deaths (4.8%). Predictors of operative mortality were prosthetic valve endocarditis, preoperative shock, and annular abscess. Patients were followed for 1 month to 130 months (mean follow-up, 43 months). Only 1 patient required reoperation for persistent infection. There were ten late deaths. Most survivors (96%) are currently in New York Heart Association class I or II. The 5-year actuarial survival was 79% +/- 7%. These data demonstrate excellent results in patients with native valve endocarditis, and support the premise that patients with prosthetic valve endocarditis should have early surgical intervention.     

Immediate and long-term results of valve replacement for native and prosthetic valve endocarditis

BACKGROUND: The objective of the present study was to compare current results of prosthetic valve replacement following acute infective native valve endocarditis (NVE) with that of prosthetic valve endocarditis (PVE). Prosthetic valve replacement is often necessary for acute infective endocarditis. Although valve repair and homografts have been associated with excellent outcome, homograft availability and the importance of valvular destruction often dictate prosthetic valve replacement in patients with acute bacterial endocarditis. METHODS: A retrospective analysis of the experience with prosthetic valve replacement following acute NVE and PVE between 1988 and 1998 was performed at the Montreal Heart Institute. RESULTS: Seventy-seven patients (57 men and 20 women, mean age 48 +/- 16 years) with acute infective endocarditis underwent valve replacement. Fifty patients had NVE and 27 had PVE. Four patients (8%) with NVE died within 30 days of operation and there were no hospital deaths in patients with PVE. Survival at 1, 5, and 7 years averaged 80% +/- 6%, 76% +/- 6%, and 76% +/- 6% for NVE and 70% +/- 9%, 59% +/- 10%, and 55% +/- 10% for PVE, respectively (p = 0.15). Reoperation-free survival at 1, 5, and 7 years averaged 80% +/- 6%, 76% +/- 6%, and 76% +/- 6% for NVE and 45% +/- 10%, 40% +/- 10%, and 36% +/- 9% for PVE (p = 0.003). Five-year survival for NVE averaged 75% +/- 9% following aortic valve replacement and 79% +/- 9% following mitral valve replacement. Five-year survival for PVE averaged 66% +/- 12% following aortic valve replacement and 43% +/- 19% following mitral valve replacement (p = 0.75). Nine patients underwent reoperation during follow-up: indications were prosthesis infection in 4 patients (3 mitral, 1 aortic), dehiscence of mitral prosthesis in 3, and dehiscence of aortic prosthesis in 2. CONCLUSIONS: Prosthetic valve replacement for NVE resulted in good long-term patient survival with a minimal risk of reoperation compared with patients who underwent valve replacement for PVE. In patients with PVE, those who needed reoperation had recurrent endocarditis or noninfectious periprosthetic dehiscence.