Long-term survival after aortic valve replacement for native active infective endocarditis

Autor: Giulio Pompilio, Philippe Eucher, Jean-Claude Schoevaerdts, Michel Buche, C Brockmann, Jules Jamart, Mohammed Amrani, Yves Louagie, Michael Bruneau, Jean Rubay, Robert Dion
Přispěvatelé: Neurosurgery
Rok vydání: 1998
Předmět:
Adult
Male
medicine.medical_specialty
Adolescent
Aortic Valve Insufficiency/etiology
medicine.medical_treatment
Aortic Valve Insufficiency
Streptococcal Infections/complications
Endocarditis
Bacterial/complications
Belgium
Valve replacement
Aortic valve replacement
Streptococcal Infections
Internal medicine
medicine
Humans
risk factors
Endocarditis
Radiology
Nuclear Medicine and imaging
Child
Belgium/epidemiology
Heart Failure/etiology
Aged
Proportional Hazards Models
Retrospective Studies
Heart Failure
Heart Valve Prosthesis Implantation
Tricuspid valve
business.industry
Proportional hazards model
Mortality rate
Endocarditis
Bacterial
Heart Valve Prosthesis Implantation/mortality
Staphylococcal Infections
Middle Aged
medicine.disease
aortic valve
Surgery
Survival Rate
Logistic Models
medicine.anatomical_structure
Heart failure
Infective endocarditis
Staphylococcal Infections/complications
Cardiology
Female
Cardiology and Cardiovascular Medicine
business
Zdroj: Cardiovascular Surgery. 6:126-132
ISSN: 0967-2109
DOI: 10.1016/s0967-2109(97)00139-7
Popis: BACKGROUND: The objective of this study was to analyse the impact of acute surgery for native aortic valve endocarditis and its influence on the long-term prognosis after surgery. METHODS: A total of 161 patients underwent aortic valve replacement for native active aortic valve endocarditis (NAAVE) during a 29-year period, from 1967 to 1995 (age range: 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, from 1978, echocardiographic evidence of friable, pedunculated vegetations (3%). Streptococcal and staphylococcal infections predominated. Concomitant procedures were performed in 27% of the patients, including mitral and tricuspid valve surgery and coronary bypass procedures. RESULTS: Operative mortality was 8% in the majority of cases caused by heart failure or multi-organ failure. Multivariate logistic regression analysis identified NYHA class IV to be an independent predictor for postoperative 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/year. Cox regression analysis identified the year of operation, trivalvular endocarditis and staphylococcal infection as independent predictors of survival. At 10 and 15 years after aortic valve replacement, 91% and 84% of the patients, respectively, were free of recurrent endocarditis. The presence of an abscess cavity at first operation was found to be predictive of recurrent endocarditis. CONCLUSIONS: Valve replacement for NAAVE offers a good chance for a cure and satisfactory long-term survival. Improvements in pre- and per-operative management of the very ill patient, and the use of allograft valves are likely to further improve long-term results. Finally, the presence of staphylococcal endocarditis requires long-term postoperative antibiotic therapy.
Databáze: OpenAIRE
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