Surgical management for active infective endocarditis: A single hospital 10 years experience |
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Authors: | Rasoul Azarfarin Azin Alizadehasl Farnaz Sepasi Medical Student |
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Institution: | (1) Cardiovascular Research Center of Tabriz University of Medical Sciences, Madani Heart Hospital, Tabriz, Iran |
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Abstract: | Objective Surgical treatment of active infective endocarditis (IE) requires not only homodynamic repair, but also, special emphasis
on the eradiation of the infection to prevent recurrence. This study was undertaken to examine the outcome of surgery for
active infective endocarditis.
Methods One hundred sixty-four consecutive patients (pts) underwent valve surgery for active IE in Madani Heart Centre (Tabriz, Iran)
from 1996 to 2006. Patients presenting with IE diagnosis (according to Duke Criteriaset) were eligible for study.
Results The mean age of patients was 36.3±16 years overall: 34.6±17.5 years for native valve endocarditis and 38.6±15.2 years for
prosthetic valve endocarditis (p=0.169). Ninety one (55.5%) of patients were men. The infected valve was native in 112 (68.3%)
of patients and prosthetic in 52 (31.7%). In 61 (37%) patients, no predisposing heart disease was found. The aortic valve
was infected in 78 (47.6%), the mitral valve in 69 (42.1%), and multiple valves in 17 (10.3%) of patients. Active culture-positive
endocarditis was present in 81 (49.4%) whereas 83 (50.6%) patients had culture-negative endocarditis. Staphylococcus aureus
was the most common isolated microorganism. Ninety patients (54.8%) were in NYHA classe III and IV. Mechanical valves were
implanted in 69 patients (42.1%) and bioprostheses in 95 (57.9%), including homograft in 19 (11.5%). There were 16 (9%) operative
deaths, but there was only 1 death in patients that underwent aortic homograft replacement. Reoperation was required in 18
(10.9%) of cases. On multivariate logistic regression analysis, Staphylococcus aureus infection (p=0.008), prosthetic valve
endocarditis (p=0.01), paravalvular abscess (p=0.001) and left ventricular ejection fraction less than 40% (p=0.04) were independent
predictors of inhospital mortality.
Conclusions Surgery for infective endocarditis continues to be challenging and associated with high operative mortality and morbidity.
Prosthetic valve endocarditis, impaired ventricular function, paravalvular abscess and Staphylococcus aureus infection adversely
affect in-hospital mortality. Also we found that aortic valve replacement with an aortic homograft can be performed with acceptable
in hospital mortality and provides satisfactory results. |
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Keywords: | Hemodynamics Aortic value replacement Surgery |
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