LONG-TERM SURVIVAL AFTER AORTIC-VALVE REPLACEMENT FOR NATIVE ACTIVE INFECTIVE ENDOCARDITIS

Background: The objective of this study was to analyse the impact of a cute surgery for native aortic valve endocarditis and its influence on the long-term prognosis after surgery. Methods: A total of 161 patien ts underwent aortic valve replacement for native active aortic valve e ndocarditis (NAAVE) during a 29-year period. from 1967 to 1995 (age ra nge: 10 to 72 years: mean 48 +/- 12), The main indication for surgery was progressive congestive heart failure (76%). Other indications were untreatable sepsis (27%), peripheral or central emboli (12%) and, fro m 1978, echocardiographic evidence of friable, pedunculated vegetation s (3%). Streptococcal and staphylococcal infections predominated. Conc omitant procedures were performed in 27% of the patients. including mi tral and tricuspid valve surgery and coronary bypass procedures. Resul ts: Operative mortality was 8% in the majority of cases caused by hear t failure or multiorgan failure. Multivariate logistic regression anal ysis identified NYHA class IV to be an independent predictor for posto perative death. Long-term survival for discharged patients was 75% at 10 years and 58% at 15 years, with a mortality rate of 3.6%/patient/ye ar. Cox regression analysis identified the year of operation. trivalvu lar endocarditis and staphylococcal infection as independent predictor s of survival. At 10 and 15 years after aortic valve replacement, 91% and 84% of the patients. respectively, were free of recurrent endocard itis, The presence of an abscess cavity at first operation was found t o be predictive of recurrent endocarditis, Conclusions: Valve replacem ent for NAAVE offers a good chance for a cure and satisfactory long-te rm survival. Improvements in pre- and per-op-rative management of the very ill patient. and the use of allograft valves are likely to furthe r improve long-term results. Finally, the presence of staphylococcal e ndocarditis requires long-term postoperative antibiotic therapy. (C) 1 998 The International Society for Cardiovascular Surgery. Published by Elsevier Science Ltd. All rights reserved.