SURGERY IN NATIVE VALVE ENDOCARDITIS - INDICATIONS, RESULTS AND RISK-FACTORS

Seventy-nine patients (mean age 49 years) underwent valve replacement or repair for active (58.2%) or healed (41.8%) native valve endocarditis between 1976 and 1992, The most common indication for surgery was congestive heart failure (73.4 %), followed by multiple systemic emboli (21.5 %). Emergency operation was necessary in 27.8 % of the cases, Operative mortality was 3.8 % (3 patients) and late mortality 15.1% (12 patients), Streptococci were the most common infecting agents (41.8%), followed by Staphylococcus aureus (11.4 %), No organisms were isolated in 27 cases (34.2 %). Follow-up spanned 379.8 patient-years with a maximum of 15.8 years, Fifteen late valve-related events (periprosthetic leak, recurrent endocarditis, thrombo-embolic events and hemolysis) and 20 other late complications (anticoagulant-related hemorrhage, arrhythmias or congestive heart failure) occurred in 22 patients, The linearized rate for all late complications is 5.8% per patient-year, The influence of eight preoperative variables on overall mortality and late valve-related complications was assessed: age, valve(s) affected, active or healed infection, bacteriology, annular abscess, emergency or elective surgery, preoperative renal function and NYHA class, Only Staphylococcus au:reus (P= 0.0012) was a significant predictor of late valve-related complications, Furthermore, no difference in survival or in valve-related complications was found between the active and healed infections.