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Original Research

RMJ. 2007; 32(2): 168-172


Surgical Management for Active Infective Endocarditis: A Single Hospital 10 Years Experience

R. Parvizi, M. Varshouchi, R. Azarfarin, A. Alizadeh, R. Mahmoudian.




Abstract

Objective: To examine the outcome of
surgery for active infective endocarditis
(IE) in a cohort of patients.
Methods: One hundred sixty-four
consecutive patients who underwent valve
surgery for active IE (diagnosis according
to Duke criteria) in Madani Heart Center,
Tabriz, Iran from 1996 to 2006 were
studied.
Results: The mean age of patients was
36.3±16 years overall: 34.6±17.5 years
for native valve endocarditis and
38.6±15.2 yrs for prosthetic valve
endocarditis (p=0.169). Ninety one
(55.5%) patients were men. The infected
valve was native in 112 (68.7%) of
patients and prosthetic in 52(31.3%). In
61 (37%) patients, no predisposing heart
disease was found. The aortic valve was
infected in 78 (47.6%), mitral valve in 69
(42.1%), and multiple valves in 17
(10.3%) of patients. Active culturepositive
endocarditis was present in 81
(49.4%) whereas 83 (50.6%) patients had
culture-negative endocarditis.
Staphylococcus aureus was the most
common isolated microorganism. Ninety
patients (54.8%) were in NYHA classes
III and IV. Mechanical valves were
implanted in 69 patients (42.1%) and
bioprostheses in 95 (57.9%), including a
homograft in 19 (11.5%). There were 16
(9%) operative deaths, but there was only
1 death in patients that underwent aortic
homograft replacement. Reoperation was
required in 18 (10.9%) of cases. On
multivariate logistic regression analysis,
Staphylococcus aureus infection
(p=0.008), prosthetic valve endocarditis
(p=0.01), paravalvular abscess (p=0.001)
and left ventricular ejection fraction less
than 40% (p=0.04) were independent
predictors of in-hospital mortality.
Conclusions: Surgery for infective
endocarditis continues to be challenging
and associated with high operative
mortality and morbidity. Prosthetic valve
endocarditis, impaired ventricular
function, paravalvular abscess and
Staphylococcus aureus infection
adversely affect in-hospital mortality.
Also we found that aortic valve
replacement with an aortic homograft can
be performed with acceptable in hospital
mortality and provides satisfactory
results. (Rawal Med J 2007;32:168-172).

Key words: Endocarditis, mechanical valve, bioprosthesis, aortic homograft.






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