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Ann Thorac Surg 1997;63:1737-1741
© 1997 The Society of Thoracic Surgeons

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Original Article: Cardiovascular

Active Native Valve Endocarditis: Determinants of Operative Death and Late Mortality

Department of Thoracic and Cardiovascular Surgery, Pitie's Hospital, Paris, France

Accepted for publication December 26, 1996.

	Abstract

Top Footnotes Abstract Introduction Patients and Methods Statistical Analysis Preoperative Patient... Surgical Findings Results Follow-up Comment Appendix 1. List of... References

 
Background. In this report, we reviewed 247 patients who underwent operation by our team for active native valve endocarditis between January 1979 and December 1993.

Methods. There were 201 male and 46 female patients (mean age, 45.4 ± 6 years). The aortic valve was involved in 163 cases, the mitral valve in 36 cases, both mitral and aortic valves in 44 cases, and the tricuspid valve alone in 4 cases. The most common microorganisms were streptococci. Univariate Pearson (² test) and multivariate (stepwise logistic regression [BMDPLR]) analyses were used to identify significant predictors of operative mortality, reoperation, and recurrent endocarditis. Cox proportional hazards regression model was used to study late survival.

Results. Operative mortality was 7.6% (n = 19). Increased age, cardiogenic shock at the time of operation, insidious illness, and greater thoracic ratio (>0.5) were the predominant risk factors; the length of antibiotic therapy appeared to have no influence. Two hundred thirteen patients were followed up. Median follow-up time was 6 years (range, 2 to 19 years). Overall survival rate (operative mortality excluded) was 71.3% ± 3.8% at 9 years. Increased age, preoperative neurologic complications, cardiogenic shock at the time of operation, shorter duration of the illness, insidious illness before the operation, and mitral valve endocarditis were the predominant risk factors for late mortality. The probability of freedom from reoperation (operative mortality included) was 73.3% ± 4.2% at 8 years; risk factors were younger age and aortic valve endocarditis. The rate of prosthetic valve endocarditis was 7%. No significant risk factor was found.

Conclusions. Increased age, insidious illness, and hemodynamic failure are the main risk factors for operative mortality. Long-term survival is good except for patients with preoperative neurologic complications and mitral valve endocarditis.

	Introduction

Top Footnotes Abstract Introduction Patients and Methods Statistical Analysis Preoperative Patient... Surgical Findings Results Follow-up Comment Appendix 1. List of... References

 
In the past years, cardiac surgery [1–3] has become increasingly important in the treatment of active native valve endocarditis (NVE). So we decided to review 247 patients who underwent operation by our team for active NVE, and we tried to identify predictors of operative and late mortality, late reoperation, and recurrent endocarditis.

	Patients and Methods

Top Footnotes Abstract Introduction Patients and Methods Statistical Analysis Preoperative Patient... Surgical Findings Results Follow-up Comment Appendix 1. List of... References

 
From January 1979 to December 1993, we operated on 247 patients for active NVE. There were 201 male and 46 female patients. Mean age was 45.4 ± 5.6 years (range, 8 to 79 years). Forty-seven patients were 60 years old and older. There were 3 drug addicts. The aortic valve was involved in 163 patients (65.6%), the mitral valve in 36 patients (14.6%), both mitral and aortic valves in 44 patients (17.8%), and the tricuspid valve alone in 4 patients (1.6%).

Endocarditis was labeled active if the patient required an operation before completion of a standard course of antibiotic treatment, irrespective of whether there were ongoing signs of sepsis, or whether blood and valve cultures were positive for the infective microorganism. The duration of antibiotic treatment was dependent on the severity of the sepsis and the responsible microorganism [4]. Early prosthetic valve endocarditis (PVE) was present if recurrent or persistent endocarditis occurred within 60 days after the operation; endocarditis occurring after 60 days was labeled late PVE. Histopathologic findings confirmed the diagnosis in all the cases.

Operative mortality was defined as death occurring within the same hospitalization after the operation.

Data were obtained from hospital records. Data on outcome after discharge and clinical status at follow-up were obtained by questionnaires. Complications were confirmed by contacting the referring physician. Follow-up was 95% complete; the total follow-up time was 1,160 patient-years. Median follow-up was 6 years.

	Statistical Analysis

Top Footnotes Abstract Introduction Patients and Methods Statistical Analysis Preoperative Patient... Surgical Findings Results Follow-up Comment Appendix 1. List of... References

 
Standard methods incorporating the BMDP statistical software package (Los Angeles, CA) were used. Univariate (Pearson ² test) and multivariate (stepwise logistic regression [BMDPLR]) analyses were used to identify significant predictors of operative mortality, reoperation, and recurrent endocarditis. The list of variables is shown in Appendix 1. Kaplan-Meier survival curves were used for analysis of long-term survival, freedom from reoperation, and freedom from recurrent endocarditis. A combination of variables related to late survival was examined using a Cox proportional hazards regression model. All the covariates, except echocardiographic data, were included in the multivariate analyses. Statistical significance was defined as a value of p less than 0.05.

	Preoperative Patient Characteristics

Top Footnotes Abstract Introduction Patients and Methods Statistical Analysis Preoperative Patient... Surgical Findings Results Follow-up Comment Appendix 1. List of... References

 
Symptom duration before the operation was between 1 and 15 days in 11 cases, between 15 and 30 days in 60 cases, between 1 and 2 months in 115 cases, and greater than 2 months in 40 cases. It was difficult to quantify it in 21 cases, the illness being insidious and atypical; among these 21 patients, 15 lived in poor socioeconomic conditions. The average symptom duration was 60.5 days.

Bacteriologic findings are listed in Table 1. Seventy-four patients (29.9%) had negative blood cultures; most of them had received antibiotic therapy before referral to our hospital. The duration of antibiotic therapy before the operation was between 1 and 15 days in 56 patients, between 15 and 30 days in 92 patients, and between 30 and 40 days in 81 patients. Sixteen patients received no antibiotic therapy because of urgency or misdiagnosis. The average duration of antibiotic administration was 24.6 days.

Six patients were in cardiogenic shock at the time of the operation and required inotropic support. Five patients needed mechanical ventilation.

Neurologic complications related to endocarditis occurred in 26 patients: brain abscess in 1, meningitis in 4, mycotic aneurysm in 1, and stroke in 20. There was no hemorrhagic infarct.

The diagnosis of coronary arterial embolism was made in 5 young patients who had electrocardiographic and echocardiographic signs of acute myocardial infarction.

Mean cardiothoracic ratio was 0.53 ± 5.6 (range, 0.4 to 0.9). It was greater than 0.5 in 155 cases, and 0.5 or less in 92 patients.

Echocardiographic data were available in 193 patients: mean left ventricular telediastolic diameter was 61.5 ± 10.5 mm (range, 60 to 90 mm), and mean left ventricular telesystolic diameter was 40.3 ± 8.7 mm (range, 10 to 80 mm). Aortic annulus abscesses were detected preoperatively in 20 patients by transesophageal echocardiography.

The predominant indication for operation was progressive hemodynamic compromise (77% of patients).

	Surgical Findings

Top Footnotes Abstract Introduction Patients and Methods Statistical Analysis Preoperative Patient... Surgical Findings Results Follow-up Comment Appendix 1. List of... References

 
Forty-five aortic annulus abscesses were found: 10 were repaired by primary suture, 34 by autologous pericardial patches, and 1 by a subcoronary valved conduit. At the mitral level, two annular abscesses were found. One was cured by primary suture, the other by intraatrial insertion of the prosthesis. Two hundred twenty-one mechanical and 70 biologic valves were inserted. No homograft was used; no mitral repair and no coronary artery bypass were performed.

Tissue and valve cultures tested positive for infection in 31 cases (13%).

	Results

Top Footnotes Abstract Introduction Patients and Methods Statistical Analysis Preoperative Patient... Surgical Findings Results Follow-up Comment Appendix 1. List of... References

 
Operative Mortality
The operative mortality was 7.6% (n = 19). Twelve patients died of hemodynamic failure, 2 of neurologic complications, 2 of pulmonary infection, and 3 of mixed causes. Univariate and multivariate analyses (Tables 2, 3) showed that increased age, cardiogenic shock at the time of the operation, greater cardiothoracic ratio, and insidious illness were the predominant risk factors.

	Follow-up

Top Footnotes Abstract Introduction Patients and Methods Statistical Analysis Preoperative Patient... Surgical Findings Results Follow-up Comment Appendix 1. List of... References

Overall survival rate (operative mortality excluded) was 71.3% ± 3.8% at 9 years (Fig 1). Univariate and multivariate analyses (Tables 4, 5) showed that increased age (>60 years), shorter duration of illness before the operation, insidious illness, cardiogenic shock at the time of the operation, preoperative neurologic complications, and mitral valve endocarditis were the predominant risk factors.

View larger version (11K): [in this window] [in a new window]   Fig 1. . Kaplan-Meier overall actuarial survival curve (operative mortality excluded). Numbers indicate patients alive and in follow-up at the start of the interval.

View larger version (12K): [in this window] [in a new window]   Fig 2. . Kaplan-Meier curve for freedom from reoperation (operative mortality included). Numbers indicate event-free patients at the start of the interval.

View larger version (12K): [in this window] [in a new window]   Fig 3. . Kaplan-Meier curve for freedom from persistent and recurrent endocarditis (operative mortality included). Numbers indicate event-free patients at the start of the interval.

	Comment

Top Footnotes Abstract Introduction Patients and Methods Statistical Analysis Preoperative Patient... Surgical Findings Results Follow-up Comment Appendix 1. List of... References

We find no statistical difference in operative mortality according to the microorganism; operative mortality has been reported higher with staphylococci [5], but our subgroup is perhaps too small to show this result. The length of antibiotic therapy before the operation appears to have no influence on operative mortality, as in Jubair and associates' report [6]. Preoperative neurologic complications play no role in operative mortality in our data; their incidence (10.5%) is lower here than in other reports [7]. Patients with cerebral events were screened preoperatively by computed tomographic scan. In case of an ischemic stroke without surrounding edema, the operation was not delayed; if there was a brain hemorrhage, patients were not operated on during the acute phase of the endocarditis. This policy can explain our results. Ting and associates [8] also have shown that operative mortality is increased in the presence of a preoperative hemorrhagic infarct but not in the presence of an ischemic infarct.

Congestive heart failure has been shown to be an important prognostic indicator of death [2, 3, 9]. Univariate and multivariate analyses show in this report that patients in cardiogenic shock are at a higher risk of death. New York Heart Association functional class and left ventricular echocardiographic diameter were not significantly correlated to operative mortality; New York Heart Association functional class is perhaps not too accurate to evaluate hemodynamic status. Echocardiographic data were available in only 193 patients, and were excluded from the multivariate analysis for this reason. In contrast, cardiothoracic ratio is well correlated to operative mortality, but we have not studied the relation with pericardial effusion.

The insidious, unknown evolution of the disease is a risk factor; in this group, patients who lived in poor social conditions came later to operation and were in a worse general and hemodynamic status at this time.

Increased age is another risk factor, as shown by multivariate analysis. Age remains a concern in Western countries: their population is becoming older, and a ninefold increased rate of endocarditis has been reported by Steckelberg and associates [10] in patients older than 65 years. Coronary artery disease should be studied in these patients. The presence of an annular abscess and the type of repair play no role in operative mortality. Ring abscesses were present in 21.8% of aortic and 2.5% of mitral valves (35% and 2% in Middlemost and colleagues' report [11]). They are best detected by transesophageal echocardiography [12]. Extensive destruction of the aortic root is uncommon in NVE, and abscesses can be usually repaired by pericardial patches. Only two extraannular procedures were used in this report (1 subcoronary valved conduit and 1 intraatrial prosthesis).

Overall long-term survival (operative mortality excluded) is good: 71.3% ± 3.8% at 9 years. Risk factors are shown in Tables 4 and 5. Shorter duration of the illness is also associated in Steckelberg and associates' report [10] with a higher case fatality rate; insidious illness as a risk factor for both early and late mortality has been discussed above. The lack of preoperative antibiotic therapy is a risk factor for poor long-term survival, but it seems related rather to hemodynamic instability and urgency than to the lack of antibiotics itself.

Neurologic complications appear to have some influence on the late outcome: severe neurologic sequelae can lead to death. Anticoagulation therapy can be difficult to manage in these patients. Preventing cerebral embolism remains a challenge: Steckelberg and colleagues [13] showed that the rate of embolic events declines over time, falling from 13 per 1,000 patient-days during the first week of therapy to less than 1.2 per 1,000 patient-days after completion of the second week of therapy, but ischemic stroke can reveal endocarditis. Preventing embolism by aspirin is being studied by a Canadian trial [14]; no patient received aspirin preoperatively in this study.

Mitral valve localization is a risk factor for late mortality, perhaps because of a higher rate of complications with mitral valve replacement. Conservative treatment and use of partial homografts can be of great interest [15]. In our series, the mitral valve was too destroyed, and these techniques could not be used.

During the follow-up, reoperation was necessary in 38 cases. Interpretation of the significance of the different variables is difficult, because there are many different and mixed causes. It seems, however, that younger age and aortic valve endocarditis are the predominant risk factors. In these data, annular abscesses at the first operation have no influence on the rate of reoperation, perhaps because of the absence of extensive aortic root destruction.

Three patients had early PVE and 13 had late PVE. The rate of recurrent endocarditis was 7%. Some authors have incriminated the use of mechanical valves. But Grover and associates [16] found no difference in the susceptibility of mechanical versus bioprosthetic valves to the development of endocarditis. The use of homografts in the aortic position could reduce the incidence of endocarditis, especially in the first 6 weeks postoperatively [9, 17] but we do not have experience with this. Operation during the acute phase of the endocarditis has been suspected to predispose to early PVE [16]. Aranki and associates found the same result for aortic [2] but not for mitral endocarditis [18]. Like Jubair and colleagues [6] and Tornos and co-workers [19], we did not find this result in our data.

In conclusion, in active NVE operative mortality is now less than 10%. Increased age, insidious illness, and severe hemodynamic failure are the main risk factors. Long-term survival is good, except for patients who had preoperative brain complications and mitral valve endocarditis.

	Appendix 1. List of the Variables

Top Footnotes Abstract Introduction Patients and Methods Statistical Analysis Preoperative Patient... Surgical Findings Results Follow-up Comment Appendix 1. List of... References

	Footnotes

Top Footnotes Abstract Introduction Patients and Methods Statistical Analysis Preoperative Patient... Surgical Findings Results Follow-up Comment Appendix 1. List of... References

 
Address reprint requests to Dr Jault, Cardiovascular Unit, Pitie's Hospital, 47-83 Blvd de l'Hôpital, 75013 Paris, France.

	References

Top Footnotes Abstract Introduction Patients and Methods Statistical Analysis Preoperative Patient... Surgical Findings Results Follow-up Comment Appendix 1. List of... References

 

1. Larbalestier R, Kinchla N, Aranki S, Couper G, Collins J, Cohn L. Acute bacterial endocarditis: optimizing surgical results. Circulation 1992;86(Suppl 2):68–74.
2. Aranki S, Santini F, Adams D, et al. Aortic valve endocarditis. Determinants of early survival and late morbidity. Circulation 1994;90(Suppl 2):175–82.
3. Verheul H, Renee B, Vanden Brink A, et al. Effects of changes in management of active infective endocarditis on outcome in a 25-year period. Am J Cardiol 1993;72:682–7.[Medline]
4. Wilson WR, Karchmer AW, Dajani AS, et al. Antibiotic treatment of adults with infective endocarditis due to streptococci, enterococci, staphylococci, and Hacek microorganisms. JAMA 1995;274:1706–13.[Abstract/Free Full Text]
5. Jaee W, Morgan D, Pearlman A, Otto C. Infective endocarditis, 1983-1988. Echocardiographic findings and factors influencing morbidity and mortality. J Am Coll Cardiol 1990;15:1227–33.[Abstract]
6. Jubair K, Al Fagih M, Ahsmed A, Belhadj M, Sawyer W. Cardiac operations during active endocarditis. J Thorac Cardiovasc Surg 1992;104:487–90.[Abstract]
7. Kanter M, Hart R. Neurologic complications of infective endocarditis. Neurology 1991;41:1015–20.[Abstract/Free Full Text]
8. Ting W, Silverman N, Levitsky S. Valve replacement in patients with endocarditis and cerebral septic emboli. Ann Thorac Surg 1991;51:18–22.[Abstract]
9. McGiffin DC, Galbraith AJ, McLachlan GJ, et al. Aortic valve infection. Risk factors for death and recurrent endocarditis after aortic valve replacement. J Thorac Cardiovasc Surg 1992;104:511–20.[Abstract]
10. Steckelberg SJ, Melton L, Ilstrup D, Rouse M, Wilson W. Influence of referral bias on the apparent clinical spectrum of infective endocarditis. Am J Med 1990;88:582–8.[Medline]
11. Middlemost S, Wisenbauch T, Meyerowitz NC, et al. A case for early surgery in native left sided endocarditis complicated by heart failure: results in 203 patients. J Am Coll Cardiol 1991;18:663–7.[Abstract]
12. Daniel W, Mugge A, Martin R, et al. Improvement in the diagnosis of abscesses associated with endocarditis by transesophageal echocardiography. N Engl J Med 1991;324:795–800.[Abstract]
13. Steckelberg J, Murphy J, Ballard D, et al. Emboli in infective endocarditis: the prognostic value of echocardiography. Ann Intern Med 1991;114:635–40.
14. Chan K, Auclair F, Moher D, Laupacis A, Hendry P, for the CATIE investigators. Role of aspirin in the prevention of embolism in infective endocarditis. Circulation 1994;90(Suppl 1):121.[Abstract/Free Full Text]
15. Acar C, Deloche A, Farge A, et al. A new surgical approach in aute mitral valve endocarditis: partial or total replacement using a mitral homograft. Circulation 1994;90(Suppl 1):310.
16. Grover FL, Cohen DJ, Oprian C, et al. Determinants of the occurrence and of survival from prosthetic valve endocarditis. J Thorac Cardiovasc Surg 1994;108:207–14.[Abstract/Free Full Text]
17. Haydock D, Barratt-Boyes B, Macedo T, et al. Aortic valve replacement for active infectious endocarditis in 108 patients. J Thorac Cardiovasc Surg 1992;103:130–9.[Abstract]
18. Aranki SF, Adams DH, Rizzo RJ, et al. Determinants of early mortality and late survival in mitral valve endocarditis. Circulation 1995;92(Suppl 2):143–9.[Abstract/Free Full Text]
19. Tornos M, Permanger Miralda G, Olena M, et al. Long term complications of native valve endocarditis in non addicts. Ann Intern Med 1992;117:567–72.

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This Article Abstract Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Valéria Bors Patrick Nataf Alain Pavie Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Jault, F. Articles by Cabrol, C. Search for Related Content PubMed PubMed Citation Articles by Jault, F. Articles by Cabrol, C.