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The Annals of Thoracic Surgery, Vol 40, 429-438, Copyright © 1985 by The Society of Thoracic Surgeons
RS D'Agostino, DC Miller, EB Stinson, RS Mitchell, PE Oyer, SW Jamieson, JC Baldwin and NE Shumway
The influence of 27 variables on operative mortality and late complications
(defined as residual or recurrent endocarditis or late bland periprosthetic
leak) was determined using discriminant analysis for 108 patients
undergoing valve replacement for native valve endocarditis at Stanford
University Medical Center from March, 1964, to January, 1983. Congestive
heart failure was the indication for valve replacement in 86% of patients.
Aortic valve replacement was required in 68% and mitral valve replacement,
in 26%. Patients were arbitrarily defined as having active (58%) or healed
(42%) endocarditis. Follow-up included 515 patient-years and extended to a
maximum of 19 years. Operative mortality was 15 +/- 4%, and 17 patients had
late complications (linearized rate, 3.3% per patient-year). Seven
variables were significantly related to operative mortality in the
univariate analysis, but only organism (Staphylococcus aureus versus all
others, p = 0.0302) was a significant independent predictor of operative
mortality. For late complications, only 2 of 7 significant univariate
covariates proved to be significant independent determinants: organisms on
valve culture or gram stain and the presence of annular abscess. Patients
with S. aureus endocarditis not showing prompt response to antibiotic
treatment must be considered for early operation. Similarly, timely
operative intervention for patients with annular abscess will be essential
in decreasing late valve infections and perivalvular leaks.
ARTICLES
Valve replacement in patients with native valve endocarditis: what really determines operative outcome?
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