RISK-FACTORS FOR EARLY AND LATE OUTCOME AFTER SURGICAL-TREATMENT OF NATIVE INFECTIVE ENDOCARDITIS

Cardiac valve replacement was performed on 76 patients with acute or subacute native infective endocarditis. The 30-day mortality/5-year survival (%percnt;plusmn;SE) was 18/67±7, after aortic valve replacement (n=50), 6/82±10 in the mitral group (n=18) and 38/63±17 after double valve replacement (n=8): NS/NS. In patients with destruction and/or abscess of the anulus (DESAB), which was commonest in the aortic group, the corresponding figures were 31/48±10, compared with 10/81±6 in the other patients (p<0.05/<0.01). Atrioventricular block and complete bundle branch block were commoner in the former group. When the time from onset of fever to operation was 1-6 months (n=50), the 5-year survival was 79±6% compared with 51±10% (p<0.05) when that time was <1 month (n=14) or >6 months (n=12). Logistic regression analysis showed NYHA class III-IV and DESAB to be independent risk factors in 30-day mortality, which was 3.8% when neither, and 46.2% when both of these factors were present (p<0.01). Cox regression analysis identified NYHA class IV (p<0.0001), calcified mitral valve or anulus (p=0.001), DESAB (p=0.01), male gender (p=0.02), supraventricular arrhythmia (p=0.04) and vegetations on the diseased valve (p=0.05) as independent determinants of overall long-term mortality. Patients with none (n=6), any one (n=16), arty two (n=28), any three (n=20), any four (n=6) or any five (n=2) of these risk factors (none had 6) had respective 30-day/5-year survival rates (%plusmn;SE) of 100/100, 94±6/94±6, 89±6/85±7, 75±10/43±13, 67±9/17±15 (at 1 year) and 0/0 (p<0.0001). Identification of independent risk factors permitted stratification of the patients into subgroups with prognosis ranging from 100% 5-year survival to 0% 30-day survival. Surgical treatment of native infective endocarditis should be undertaken before cardiac disability is advanced or infective destruction of the anulus, notably of the aortic valve, becomes evident. © 1990 Informa UK Ltd All rights reserved: reproduction in whole or part not permitted.