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Long-Term Results and Determinants of Mortality after Surgery for Native and Prosthetic Valve Endocarditis The study aim was to detail long-term results and determinants of mortality after surgical treatment of native (NVE) and prosthetic valve endocarditis (PVE) at a single institution. Between March 1985 and October 1999, 171 patients underwent surgery for NVE (n = 98; 57%) or PVE (n = 73; 43%). Mean follow up was 5.6 ± 3.9 years (range: 0 to 15 years). Overall hospital mortality was 9.9% (n = 17) and was higher among PVE patients (15.1%) than NVE patients (6.1%) (p = 0.05). Overall survival at 10 years was 46 ± 5%. NVE patients had a higher 10-year survival (53 ± 7%) than PVE patients (37 ± 7%) (p = 0.02). At 10 years, overall freedom from any late complication was 47 ± 6% and from residual or recurrent endocarditis was 78 ± 5%. Predictors of hospital death were emergency surgery (p <0.003) and preoperative renal insufficiency (p <0.008). Predictors of late death were age >70 years (p <0.002), renal failure (p <0.03) and fungal endocarditis (p <0.04). These findings demonstrate the increased perioperative and postoperative risks associated with PVE versus NVE. Cardiac and extracardiac manifestations of the disease, as well as fungal organisms, but not the activity of the endocarditis, were significant adverse determinants of late outcome. |
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