Parvizi R, Varshouchi M, Azarfarin R, Alizadeh A, Mahmoudian R.
Surgical management for active infective endocarditis: a single hospital 10 years experience.
Rawal Med J Jan ;32(2):168-72.

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 culture-positive 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).

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