Long-Term Clinical Outcomes and Predictors of Survival after Prosthetic Valve Endocarditis Surgery

Background and aim of the study: The study aim was to comprehend the outcomes of surgery for prosthetic valve endocarditis (PVE) over 25 years and to identify predictors for patient survival.

Methods: A total of 47 consecutive patients (19 males, 28 females; mean age 67.0 ± 11.5 years) who underwent surgery for PVE between 1986 and 2011 was analyzed. Typically, PVE appeared at 4.2 ± 6.2 years after valve replacement. Preoperative and postoperative clinical variables were evaluated; the mean follow up was 6.4 ± 5.3 years.

Results: The incidence of PVE was 3.9% for 1,185 cases of valve replacement through the study period. Operative mortality was 17.0%. NYHA functional class IV (p = 0.01), preoperative shock (p = 0.03) and renal failure (p = 0.02)

were each independent predictors of operative mortality. Survival was 69.1 ± 9.3% at 10 years and 59.2 ± 12.1% at both 15 and 20 years. Preoperative impaired left ventricular function (p = 0.02) and preoperative renal failure (p = 0.04) were independent predictors of late mortality. Freedom from recurrent PVE remained at 82.5 ± 6.0% from two years up to 20 years after surgery. Initial infective endocarditis (p = 0.03) and postoperative heart failure (p = 0.04) were predictors of recurrent PVE. Freedom from reoperation was 84.8 ± 5.7% at 10 years, and 72.6 ± 12.2% at both 15 and 20 years.

Conclusion: This extensive examination revealed that critical preoperative conditions determine not only short-term but also long-term mortality after surgery to treat PVE. Hence, a timely surgical intervention and close follow up are crucial for patient survival.

The Journal of Heart Valve Disease 2013;22:704-712