| Surgical Treatment of Active
Infective Endocarditis: Determinants of Early Outcome |
(Department of Cardiovascular Surgery, Hokkaido
University School of Medicine, Sapporo, Japan)
| Yasuhiro Kamikubo |
Toshifumi Murashita |
Hideyuki Kunishige |
| Norihiko Shiiya |
Keishu Yasuda |
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The purpose of this study was to
review our experience in the treatment of active endocarditis
and identify determinants of early outcome. Sixty-nine patients
(mean age 47.3 years, range 5 months to 88 years) underwent surgery
for active endocarditis. Native valve endocarditis was present
in 59 (85.5%) and prosthetic valve endocarditis in 10 (14.9%).
The aortic valve was infected in 26 (37.7%), the mitral valve
in 24 (34.8%), both aortic and mitral valves in 13 (18.8%), and
the tricuspid in 3 (4.3%). Paravalvular abscess was identified
in 22 (31.9%). Streptococci (27.5%) and Staphylococci
(23.3%) were the most common pathogens, but the pathogen was
not identified in 36.2%. Hospital death occurred in 13 (18.8%),
and causes of deaths included cardiac failure in 6 and sepsis
in 5. There were 2 late deaths, and the causes of death were
cerebral infarction and renal dysfunction. Univariate analysis
indicated that older age (p＝0.02), New York Heart Association
class III or IV（p＝0.02), a preoperatively unidentified
pathogen（p＝0.02）and concomitant operation for abscess
and fistula (p＝0.04) were significant risk factors in hospital
mortality. Prosthetic valve infection was a relative risk factor
in hospital mortality (p＝0.11). Multivariate analysis
revealed that NYHA III -IV (p＝0.02, odds ratio＝18.1, 95%
CI＝1.49 -220.1) and a preoperatively unidentified pathogen (p＝0.02,
odds ratio＝7.45, 95% CI＝1.44 -38.5) were independent predictors
of hospital mortality. To reduce hospital mortality in active
endocarditis, early surgical intervention is recommended before
the involvement of heart failure, particularly when the pathogen
is not identified.
Jpn. J. Cardiovasc. Surg. 33: 1 -5 (2004) |
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