EARLY AND LATE SURVIVAL AFTER SURGICAL-TREATMENT OF CULTURE-POSITIVE ACTIVE ENDOCARDITIS

Objective: To describe a 30-year experience with surgically treated cu lture-positive active endocarditis. Design: We retrospectively reviewe d the microbiologic, clinical, and operative findings and the survival data in 151 patients with culture-positive active endocarditis encoun tered between 1961 and 1991. Results: The mean age of the 110 male and 41 female patients was 49.8 years. Native valve endocarditis was pres ent in 86 patients, and prosthetic valve endocarditis (PVE) was diagno sed in 65, The aortic valve was involved in 62% of patients, the mitra l valve in 25%, and both valves in 10%. The operative mortality was 26 %. The most important univariate determinants of mortality were an abs cess at operation (P = 0.01) and renal failure (P = 0.03). A trend tow ard a higher mortality with PVE and staphylococcal infection was noted . For hospital survivors, the 5- and 10-year survival was 71% and 60%, respectively. Univariate determinants of an adverse longterm survival were annular abscess (P = 0.01), renal impairment (P = 0.01), heart f ailure (P = 0.02), and aortic valve involvement (P = 0.05). On multiva riate analysis, the most important adverse determinants of long-term s urvival were heart failure (P = 0.02), renal impairment (P = 0.02), an d PVE (P = 0.03). Thirty patients required a subsequent reoperation; o f these, seven required a second and two a third operation. The most c ommon reason for reoperation was periprosthetic regurgitation without infection (N = 19). Four operations mere performed for recurrent endoc arditis. At 5 and 10 years, the risk of reoperation was 23% and 36%, r espectively. Conclusion: Although surgical treatment of culture-positi ve active endocarditis is still associated with substantial mortality, the long-term outcome of hospital survivors is excellent. Subsequent reoperations for periprosthetic leak are common, but recurrent infecti on is uncommon.