Surgical Treatment For Native Valve Endocarditis: 9 Years Follow-Up

【Objective】retrospective evaluation/review of 9 years experience in surgery of nativevalve endocarditis basically were aimed on preoperative risk factors, intraoperative findings,operative procedures and postoperative short and long-term outcome.【Methods】between January 2000 and February 2009, 143 (92 males and 51 females)mean age was 34 (10-75 yrs) patients with native valve endocarditis were operated (valverepair and replacement).The analysis included detailed study of hospital records and data onshort and long term follow up which were obtained in all patients by direct patients telephonecontact or their relatives using SF-36 questionnaire. Diverse surgical techniques were appliedto restore competence of the valves. HancockⅡbio-valve was used in tricuspid valve repair,whilst mitral and aortic valves were replaced with mechanical valves and those with defectswere repaired by autologous pericardial patches/baffles.【Results】The overall early operative mortality was 2 % (three patients) in NYHAⅢ-Ⅳ, multi-organ failure and history of valvular disease were the independent risk factors forearly mortality. The average follow-up time were 19 months, during this period no death wereobserved/occurred or redo surgery, and their NYHA wereⅠ-Ⅱ, no recurrence fever, one patientpresented with bleeding tendencies due to anticoagulation therapy and two patients witharrhythmias. Follow up among survivals were successful in 135 patients (93%), however 7%(five patients) did not respond either due to change of telephone numbers or the phone was notreachable or could be due to change of address..【Conclusion】By using diverse and advanced technique in valve replacement, asuccessful rate of over 90% can be reached with minimum mortality rate among patients with active or healed endocarditis. This retrospective study demonstrates that a high level of safetyand excellent durability of valve replacement can be obtained even for complex cases of nativevalve endocarditis.INTRODUCTIONInfective endocarditis is vegetation-forming disease with which microorganisms-infecting endocardium, causing local sediments of fibrin and platelets. Endocarditis representsa small percentage of cardiovascular mortality and morbidity in the United States but remains asignificant clinical challenge for cardiothoracic surgeons. Reported rates of incidence,mortality and long-term outcomes have been highly variable owing to conflicting diagnosticcriteria, differing lengths of follow-up, and highly varied patient populations. The incidence ofendocarditis in the United States is approximately 1.7 to 6.2 cases per 100000 person years.However, there is no clear data on incidence in the developing countries including China.This high incidence persists even though rheumatic heart disease, which historically wasthe major contributor to this disease, is virtually eliminated. The American Heart Associationissued a consensus statement on the diagnosis of infectious endocarditis in 1998 and estimated15,000 to 20,000 cases of endocarditis per year in the United StatesPatients at increased risk for the development of endocarditis include those withcongenital or acquired structural valvular abnormalities. Patients actively abusing intravenousdrugs (IVDA) are also at risk for the development of endocarditis, presumably from previousunrecognized episodes of endocarditis that damage the valve and leave it prone to subsequentinfection. Patients, who have recently undergone implantation of prosthetic valves, are atincreased risk for the development of endocarditis in both the immediate and, to a lesser degree,later postoperative periods. Patients with permanently implanted transvenous pacing ordefibrillation systems and those with long-term central venous access are at increased risk for 【Objective】Retrospective assessment of short and long-term outcome in elderlyundergoing primary isolated valvular heart surgery (VR). Methods: Records of 172consecutive geriatrics (range of age 65-80) having VR between 2000 and 2008 werereviewed and follow-up. The search strategy combined terms for specified cardiacsurgical procedures with terms for risk factors, age factors, outcomes and quality of life.【Results】Preoperatively, 23 patients (13%) were in NYHA function classⅣ, 71patients in classⅢand 78 patients in classⅡ. Operations were performed with urgent oremergent surgical priority in 31 patients (18%). There were four in-hospital deaths(2.3%).【Conclusions】Although open heart surgery can be safely performed in manyelderly patients, this study showed several factors that might help both in case selectionand in perioperative decisions that will determine the short and long-term outcome.