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 resul ts of prosthetic valve replacement following acute infective native valve e ndocarditis (NVE) with that of prosthetic valve endocarditis (PVE). Prosthe tic valve replacement is often necessary for acute infective endocarditis. Although valve repair and homografts have been associated with excellent ou tcome, homograft availability and the importance of valvular destruction of ten dictate prosthetic valve replacement in patients with acute bacterial e ndocarditis. Methods. A retrospective analysis of the experience with prosthetic valve r eplacement 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 ye ars) with acute infective endocarditis underwent valve replacement. Fifty p atients 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. S urvival 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, respectivel y (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 val ve replacement. Five-year survival for PVE averaged 66% +/- 12% following a ortic valve replacement and 43% +/- 19% following mitral valve replacement (p = 0.75). Nine patients underwent reoperation during follow-up: indicatio ns 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-ter m patient survival with a minimal risk of reoperation compared with patient s who underwent valve replacement for PVE. In patients with PVE, those who needed reoperation had recurrent endocarditis or noninfectious periprosthet ic dehiscence. (C) 2000 by The Society of Thoracic Surgeons.