PMID- 6823135
OWN - NLM
STAT- MEDLINE
DCOM- 19830317
LR  - 20191210
IS  - 0022-5223 (Print)
IS  - 0022-5223 (Linking)
VI  - 85
IP  - 2
DP  - 1983 Feb
TI  - Early valve replacement in active infective endocarditis. Results and late 
      survival.
PG  - 163-73
AB  - In the past 14 years, 42 patients with active infective endocarditis underwent 
      early valve replacement for severe congestive heart failure, major prosthetic 
      dehiscence, intramyocardial abscesses, sepsis, or major embolization. Blood 
      cultures were positive in 40 patients and the valve tissues were positive in two 
      others. All patients received antimicrobials for from 1 to 4 weeks. Drug 
      addiction was noted in 24%, urinary tract manipulation in 7%, dental work in 5%, 
      contaminated prosthesis in 2%, and unknown cause in 62%. Organisms were 
      predominantly staphylococcal (43%) and streptococcal (41%); the remainder were 
      gram-negative (9%) or fungal (7%). The aortic valve was involved in 72%, mitral 
      in 14%, tricuspid in 7%, and both aortic and mitral in 7%. By the New York Heart 
      Association (NYHA) functional classification, 90% (38/42) were in Class III or 
      IV. Operative mortality was 10% (4/42) and all four patients had preexisting 
      renal failure necessitating dialysis. No predominant organism correlated with 
      early deaths. In aortic valve replacement (30 patients), operative mortality was 
      7%. Postoperatively, 95% (35/37) were Class I or II with one lost to follow-up. 
      Subsequent reoperation was required in five patients (13%) for recurrent 
      endocarditis, with an operative mortality of 20% (1/5). Late death occurred in 
      45% (17/38). Overall probability of survival was 0.53 at 5 years. For isolated 
      aortic valve involvement, the 5 year survival was 0.58. Survival for native valve 
      involvement was 0.58 and for prosthetic endocarditis, 0.55. This study shows that 
      after at least 1 week of antibiotics, early operation in patients with active 
      endocarditis has an acceptable operative mortality. Clinical improvement is 
      excellent in 95% and more than half survived 5 years or longer.
FAU - Cukingnan, R A Jr
AU  - Cukingnan RA Jr
FAU - Carey, J S
AU  - Carey JS
FAU - Wittig, J H
AU  - Wittig JH
FAU - Cimochowski, G E
AU  - Cimochowski GE
LA  - eng
PT  - Journal Article
PL  - United States
TA  - J Thorac Cardiovasc Surg
JT  - The Journal of thoracic and cardiovascular surgery
JID - 0376343
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aortic Valve
MH  - Endocarditis/mortality/*surgery
MH  - Endocarditis, Bacterial/*surgery
MH  - *Heart Valve Prosthesis
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Mycoses/*surgery
MH  - Outcome and Process Assessment, Health Care
MH  - Staphylococcal Infections/*surgery
MH  - Streptococcal Infections/*surgery
MH  - Time Factors
EDAT- 1983/02/01 00:00
MHDA- 2001/03/28 10:01
CRDT- 1983/02/01 00:00
PHST- 1983/02/01 00:00 [pubmed]
PHST- 2001/03/28 10:01 [medline]
PHST- 1983/02/01 00:00 [entrez]
PST - ppublish
SO  - J Thorac Cardiovasc Surg. 1983 Feb;85(2):163-73.