Infective Endocarditis of Native Cardiac Valves: 22 Years’ Surgical Experience
Maurizio Cotrufo MD, Antonio Carozza MD, Gianpaolo Romano MD, Marisa De Feo MD, Alessandro Della Corte MD

A 22-year experience of surgery for native valve endocarditis (NVE) was reviewed. Cases of prosthetic valve endocarditis (PVE) were excluded. Among 199 patients, 185 underwent valve replacement, and 14 valve repair. Significant association was found between staphylococcal etiology and tricuspid involvement, and streptococcal etiology and mitral involvement. Echocardiography was very reliable, when compared with surgical findings, in the diagnosis of all valve lesions, except in the presence of periannular abscess. Hospital mortality was 6%. Twenty-seven late deaths occurred (15%). Actuarial survival was 75.7% at 10 years and 60.3% at 20 years. Endocarditis recurred in 28 patients (15.5%), with 74.1% freedom at 10 years and 68.7% at 20 years. In multivariate analysis, preoperative NYHA class IV and emergency surgery were shown as determinants for early mortality; a low social status, diabetes mellitus, fever at time of surgery and persistent postoperative fever for late mortality; and drug abuse, mitral endocarditis, positive blood culture, homograft implantation and persistent postoperative fever for recurrence.