Surgical treatment of aortic valve endocarditis: a 26-year experience.

OBJECTIVE: We have retrospectively analyzed the results of the operations made for aortic valve endocarditis in a single center in 26 years. METHODS: From June 1985 to January 2011, 174 patients were operated for aortic valve endocarditis. One hundred and thirty-eight (79.3%) patients were male and the mean age was 39.3±14.4 (9-77) years. Twenty-seven (15.5%) patients had prosthetic valve endocarditis. The mean duration of follow-up was 7.3±4.2 years (0.1-18.2) adding up to a total of 1030.8 patient/years. RESULTS: Two hundred and eighty-two procedures were performed. The most frequently performed procedure was aortic valve replacement with mechanical prosthesis (81.6%). In-hospital mortality occurred in 27 (15.5%) cases. Postoperatively, 25 (14.4%) patients had low cardiac output and 17 (9.8%) heart block. The actuarial survival rates for 10 and 15 years were 74.6±3.7% and 61.1±10.3%, respectively. In-hospital mortality was found to be associated with female gender, emergency operation, postoperative renal failure and low cardiac output. The long term mortality was significantly associated with mitral valve involvement. Male gender was found to be a significant risk factor for recurrence in the follow-up. CONCLUSION: Surgery for aortic valve endocarditis has significant mortality. Emergency operation, female gender, postoperative renal failure and low cardiac output are significant risk factors. Risk for recurrence and need for reoperation is low.

Surgical treatment of double valve endocarditis.

BACKGROUND: We have retrospectively analyzed the results of the operations made for aortic infective endocarditis with mitral involvement in a single center in 19 years. METHODS: From May 1992 to January 2011, we have operated on 72 patients with infective endocarditis of the aortic valve with mitral valve involvement. Fifty-two patients (72.2%) were male and the mean age was 40.5 ± 15.5 (9-73) years. The blood cultures were positive in 33 patients (45.8%) and the most commonly identified microorganism was Streptococcus. Nine patients (12.5%) had prosthetic valve endocarditis. The mean duration of follow-up was 6.8 ± 4.7 (0.1-16.9) years, adding up to a total of 156.1 patient/years. RESULTS: A total of 155 procedures were performed on these 72 patients. The most commonly performed procedure was aortic valve replacement, in 63 patients (87.5%). Aortic annular involvement was present in 9 cases (12.5%). In-hospital mortality was seen in 13 patients (18.1%). Postoperatively, 13 (18.1%) patients had low cardiac output, 9 (12.5%) had heart block, and only 1 of them required permanent pacemaker implantation. The actuarial survival rates for 1, 5, and 10 years were 96.4% ± 2.5%, 84.4% ± 5.1%, and 77.4 ± 6.7%, respectively. CONCLUSIONS: Double-valve endocarditis is a serious condition and the surgeon must be aware of the high rates of mortality and morbidity in these patients. Although no association was found, heart blocks and septic embolization must be handled with caution. The patients generally do well after surgery, and recurrences and reoperations decrease by the second year after operation.

Surgical treatment of aortic valve endocarditis: a 26-year experience / Tratamento cirúrgico da endocardite da válvula aórtica: 26 anos de experiência

Objective: We have retrospectively analyzed the results of the operations made for aortic valve endocarditis in a single center in 26 years. Methods: From June 1985 to January 2011, 174 patients were operated for aortic valve endocarditis. One hundred and thirty-eight (79.3%) patients were male and the mean age was 39.3±14.4 (9-77) years. Twenty-seven (15.5%) patients had prosthetic valve endocarditis. The mean duration of follow-up was 7.3±4.2 years (0.1-18.2) adding up to a total of 1030.8 patient/years. Results: Two hundred and eighty-two procedures were performed. The most frequently performed procedure was aortic valve replacement with mechanical prosthesis (81.6%). In-hospital mortality occurred in 27 (15.5%) cases. Postoperatively, 25 (14.4%) patients had low cardiac output and 17 (9.8%) heart block. The actuarial survival rates for 10 and 15 years were 74.6±3.7% and 61.1±10.3%, respectively. In-hospital mortality was found to be associated with female gender, emergency operation, postoperative renal failure and low cardiac output. The long term mortality was significantly associated with mitral valve involvement. Male gender was found to be a significant risk factor for recurrence in the follow-up. Conclusion: Surgery for aortic valve endocarditis has significant mortality. Emergency operation, female gender, postoperative renal failure and low cardiac output are significant risk factors. Risk for recurrence and need for reoperation is low. .

Objetivo: Analisamos, retrospectivamente, os resultados das operações realizadas para endocardite valvar aórtica em um único centro em 26 anos. Métodos: De junho de 1985 a janeiro de 2011, 174 pacientes foram operados por endocardite da válvula aórtica. Cento e trinta e oito (79,3%) pacientes eram do sexo masculino e a média de idade foi de 39,3 ± 14,4 (9-77) anos. Vinte e sete (15,5%) pacientes apresentavam endocardite na prótese valvar. O tempo médio de acompanhamento foi de 7,3 ± 4,2 anos (0,1- 18,2) totalizando 1.030,8 paciente/ano . Resultados: Duzentos e oitenta e dois procedimentos foram realizados. O procedimento mais realizado foi a substituição da valva aórtica por prótese mecânica (81,6 %). A mortalidade intra-hospitalar ocorreu em 27 (15,5%) casos. No pósoperatório, 25 (14,4% ) pacientes apresentaram baixo débito cardíaco e 17 (9,8%) bloqueio cardíaco . As taxas de sobrevida atuarial para 10 e 15 anos foram 74,6±3,7% e 61,1±10,3%, respectivamente. A mortalidade intra-hospitalar foi encontrada esteve associada com o sexo feminino, operação de emergência, insuficiência renal pós-operatória e baixo débito cardíaco. A mortalidade a longo prazo foi significativamente associada com o envolvimento da válvula mitral. O sexo masculino encontrado mostrou-se um fator de risco para a recorrência no seguimento. Conclusão: A cirurgia para tratamento da endocardite da válvula aórtica apresenta mortalidade. Operação de emergência, o sexo feminino, insuficiência renal pós-operatória e baixo débito cardíaco são fatores de risco significativos. O risco de recorrência e necessidade de reoperação são baixos. .