Outcome Of Surgical Treatment For Active Infective Endocarditis

Objective To analyze the outcomes of surgical treatment of active infective endocarditis(AIE).Methods Between January 2012 and June 2017,224 patients in Peking Union Medical College Hospital underwent surgery for AIE.154 men,70 women,mean age was 44.0±15.0 years.Native valve endocarditis(NVE)was present in 212 patients(94.6%),and 7 patients(3.1%)had prosthetic valve endocarditis(PVE).The mean follow-up period was 41.2 ± 18.5 months(maximum 6.5years).We have done the blood culture,UCG,chest CT,head CT or MRI,Coronary angiography or Coronary CTA for patients had risk factor or a history of coronary artery disease.Intraoperative TTE was used to determine the exact location and extent of infection,guide surgery,assess the result.The two primary objectives of surgery are total removal of infected tissues and reconstruction of cardiac morphology,including repair or replacement of the affected valve(s).Where infection is confined to the valve cusps or leaflets,any method to repair or replace the valve may be used.However,valve repair is favoured whenever possible,particularly when IE affects the mitral or tricuspid valve without significant destruction.Perforations in a single valve cusp or leaflet may be repaired with an untreated or glutaraldehyde-treated autologous or bovine pericardial patch.Isolated or multiple ruptured chordae may be replaced by polytetrafluoroethylene neo-chordae.If valve(s)was destoried seriously,we choose mechanical prostheses or biological materials according to the age or comorbidities of the patient,such as stroke and preoperative embolization,Statistical analyses were performed with the Statistical Package for Social Science,(SPSS).Continuous variables were expressed as either means with standard deviation or median with interquartile range,as appropriate.These were compared using two-tailed t-test,respectively.Categorical variables,expressed as percentages,were analysed with x 2 test.For factors that trended towards significance(P<0.05),Survival function and freedom from morbid events were presented using Kaplan-Meier survival curves.Results The mean fever period before diagnose was(111.4 ± 110.7)days.Most patients had a nonstandard antimicrobial therapy before hospitalization.IE with a past history of heart disease in 123(54.9%)patients,and CHD 36.6%.The number of patients before surgery with I,II,III and IV grade heart function(NYHA)were 13(5.8%),122(54.5%),49(21.9%)and 40(17.9%).UCG found vegetations in 197 patients(87.9%),pre-operation blood culture positive in 152 patients(67.9%).Neurological complications occurred in 49 patients(21.9%),stroke in 43 patients,intracranial haemorrhage in 18 patients.NVE in 212 patients(94.6%),PVE in 7 patients(3.1%).Isolate valve infection was present in 155(69.2%)patients,aortic valve in 60,mitral valve in 64,pulmonary valve in 11,and tricuspid valve in 20.Multivalve involvement was present in 69(30.8%)patients.Preoperative stroke was present in 49(21.9%)patients,while 4(1.8%)patients were on dialysis prior to surgery.Valve repair was possible in 79 patients(35.3%),while 145 patients underwent valve replacement(64.7%).Mechanical valves were used in 131(58.5%)patients,bioprosthetic valves in 14(6.3%)patients.Early surgical death occurred in 12(5.4%)patients.Overall survival at 1,5 and 6 years was 93.5%,93.0%and 91.5%,respectively.Conclusions The median age in our population was younger than other studies on IE,because most patients in our group had CHD and was NVE.Because the reason of more earlier operation,the heart function was usually preserved,we did not found the similar conclusion that higher NYHA class was associated with 30-day mortality following surgery for IE.Staphylococcus and Streptococc still were the most commonly microorganisms of IE,and blood culture negative did not influence early mortality.the modified Duke criteria may show a lower diagnostic accuracy for early diagnosis in clinical practice,but we never use PET-CT.SPECT to diagnosis IE.IE with aortic and mitral valves,secondary valve operation,intracranial haemorrhage and heart failure post-operation contribute to early mortality.Our low early mortality may associate with early surgery in active period.Left-heart IE were more common.However right-heart IE often with congenital introcardial shunts as VSD,but VSD also can lead Left heart and right heart IE.IVDU are not common in this study.Valve repair were better then replacement in patients' survival.Operation for Neurological complications needs a collaborative approach with 'Endocarditis Team' Early surgery for AIE has a satisfied early and midterm outcomes.