DETERMINANTS OF EARLY MORTALITY AND LATE SURVIVAL IN MITRAL-VALVE ENDOCARDITIS

Background Infective mitral valve endocarditis continues to be a signi ficant surgical challenge. The objective of this study was to examine our experience with mitral valve endocarditis surgery and identify det erminants of early mortality and late survival. Methods and Results Ov er a 24-year period, mitral valve surgery was performed in 96 patients for infective mitral valve endocarditis. Patient age ranged from 20 t o 78 years (median age, 52 years). There were 44 women (46%), and 48 o f the 96 patients (50%) were in New York Heart Association functional class IV before surgery. Native valve endocarditis (NVE) and prostheti c valve endocarditis (PVE) were present in 72 patients (75%) and 24 pa tients (25%), respectively, Surgery during the active phase of endocar ditis (AE) was required in 60 patients (62%) and during the healed pha se (HE) in 36 (38%). The main indications for surgery in the AE group were congestive heart failure (60%), active sepsis (67%), peripheral e mboli (47%), and acute renal failure (20%), and for the HE group the m ain indication was progressive congestive heart failure (69%). The ove rall operative mortality was 5.2%. Multivariate logistic regression an alysis identified PVE (odds ratio [OR] 22.5; +/-95% confidence interva l, CI, 1.9 to 268; P=.014) and an associated procedure (OR 13.3; +/-95 % CI, 1.5 to 120; P=.021) to be independent predictors for early morta lity. Follow-up was 97% complete, with a median of 3.5 years. Overall 5- and 10-year survivals were 83+/-4% and 63+/-8%, respectively. Multi variate analysis for late mortality identified PVE to be a significant predictor of late mortality (hazards ratio=3.1, +/-95% CI, 1.4 to 6.8 , P=.006). There were no significant differences in long-term morbidit y results among the various subsets of mitral valve endocarditis. Conc lusions Mitral valve surgery for infective endocarditis is a significa nt high-risk procedure for PVE and when combined with associated proce dures. The activity of endocarditis does not appear to have any influe nce on early mortality or long-term survival.