Surgical results for active endocarditis with prosthetic valve replacement: impact of culture-negative endocarditis on early and late outcomes

Murashita, Toshifumi; Sugiki, Hiroshi; Kamikubo, Yasuhiro; Yasuda, Keishu
December 2004
European Journal of Cardio-Thoracic Surgery;Dec2004, Vol. 26 Issue 6, p1104
Academic Journal
Abstract: Objective: Surgical treatment of active infective endocarditis requires not only hemodynamic repair, but also special emphasis on the eradiation of the infectious focus to prevent recurrence. This goal can be achieved by the combination of aggressive debridement of infective tissue and appropriate and adequate antibiotic treatment. We reviewed our experience with active endocarditis and identified factors determining early and late outcomes, particularly focusing on the factor of culture-negative endocarditis. Methods: Sixty seven patients with clinical evidence of active endocarditis who underwent operation between 1991 and 2001 were evaluated. The aortic valve was infected in 28 (42%), the mitral valve in 23 (34%), and multiple valves in 16 (24%). Native valve endocarditis was present in 58 (87%) and prosthetic valve endocarditis in 9 (13%). Mean follow-up was 5.7 years (range, 0.2–11.5 years). Results: Microorganisms were detected in 46 (69%): Staphylococcus aureus in 9 (13%), other staphylococci in 9 (13%), streprococcus species in 19 (28%), and others in 9 (28%), whereas 21 (31%) patients had culture-negative endocarditis. Operative mortality was 17.8% (12 patients). Reoperation was required in 8 (12%), while 3 late deaths (5.5% of hospital survivors) occurred. All events, including death, reoperation, periprosthetic leak, and recurrence of infection, occurred within 2 years after operation. Actuarial freedom from reoperation, late survival, and events at 5 years were 81.6, 76.4, and 68.6%, respectively. On multivariate analysis, no independent adverse predictor was detected for hospital death, whereas the following independent adverse predictors were identified: preoperative heart failure (P=0.0375), prosthetic valve endocarditis (P=0.0391) and culture-negative endocarditis (P=0.0354) for poor late survival; culture-negative endocarditis (P=0.0354) and annular abscess (P=0066) for poor event-free suvival. Freedom from events was similar between patients with Staphylococcus aureus infection (3-year freedom 55.6%) and culture-negative endocarditis (3-year freedom 47.6%), whereas events were significantly low in patients with streptococcus infection (3-year freedom 100%). Conclusions: In our analysis, no independent adverse predictor was detected for hospital death; however, culture-negative endocarditis was identified as an independent predictor for both late survival and events after surgery. Event-free survivals were similar between staphylococcus infection and culture-negative endocarditis, and all events occurred within 2 years after operation, suggesting the necessity of close follow-up during that period.


Related Articles

  • Editorial Response: Increasing Importance of Intravascular Device-Associated Staphylococcus aureus Endocarditis.  // Clinical Infectious Diseases;1/1/1999, Vol. 28 Issue 1, p115 

    Focuses on the increasing importance of intravascular device-associated Staphylococcus aureus endocarditis. Methicillin-susceptible Staphylococcus aureus in the cultures of blood and pustule specimens.

  • Infective endocarditis of the patent oval fossa assessed by three-dimensional echocardiography. Acar, Philippe; Abadir, Sylvia; Bassil, Rania // Cardiology in the Young;Feb2007, Vol. 17 Issue 1, p113 

    The article focuses on the diagnosis of a patient with infective endocarditis of the patent oval fossa, assessed by three-dimensional echocardiography. The patient was treated with intravenous antibiotics and oral aspirin. Based on observations, the presence of positive blood cultures in the...

  • Temporal Trends in Infective Endocarditis: A Population-Based Study in Olmsted County, Minnesota. Tleyjeh, Imad M.; Steckelberg, James M.; Murad, Hani S.; Anavekar, Nandan S.; Ghomrawi, Hassan M. K.; Mirzoyev, Zaur; Moustafa, Sherif E.; Hoskin, Tanya L.; Mandrekar, Jayawant N.; Wilson, Walter R.; Baddour, Larry M. // JAMA: Journal of the American Medical Association;6/22/2005, Vol. 293 Issue 24, p3022 

    Context Limited data exist regarding population-based epidemiologic changes in incidence of infective endocarditis (IE). Objective To evaluate temporal trends in the incidence and clinical characteristics of IE. Design, Setting, and Patients Population-based survey using the resources of the...

  • Coronary artery ostium occlusion—a rare manifestation of endocarditis. Sardar, Muhammad R.; Subrayappa, Navin; Badri, Marwan; Khitri, Avinash; Bradley, Jason // QJM: An International Journal of Medicine;Jun2013, Vol. 106 Issue 6, p589 

    No abstract available.

  • Staphylococcus aureus Bacteremia and Infective Endocarditis: Old Questions, New Answers? Tleyjeh, Imad M. // Mayo Clinic Proceedings;Oct2007, Vol. 82 Issue 10, p1163 

    The article discusses a report on a novel approach to Staphylococcus aureus Bacteremia (SAB) and Infective Endocarditis (IE) published within the issue.

  • Staphylococcus aureus Infections in Children With Congenital Heart Disease. McNeil, J. Chase; Ligon, John A.; Hulten, Kristina G.; Dreyer, W. Jeffrey; Heinle, Jeffrey S.; Mason, Edward O.; Kaplan, Sheldon L. // Journal of the Pediatric Infectious Diseases Society;Dec2013, Vol. 2 Issue 4, p337 

    Background Congenital heart disease (CHD) is the most common risk factor for infective endocarditis (IE) in children. Staphylococcus aureus is among the most common organisms to cause IE, yet there are little data describing the risk factors for invasive S aureus disease in children with CHD. We...

  • Staphylococcus aureus Endocarditis: A Consequence of Medical Progress. Fowler, Vance G.; Miro, Jose M.; Hoen, Bruno; Cabell, Christopher H.; Abrutyn, Elias; Rubinstein, Ethan; Corey, G. Ralph; Spelman, Denis; Bradley, Suzanne F.; Barsic, Bruno; Pappas, Paul A.; Anstrom, Kevin J.; Wray, Dannah; Fortes, Claudio Q.; Anguera, Ignasi; Athan, Eugene; Jones, Philip; van der Meer, Jan T. M.; Elliott, Tom S. J.; Levine, Donald P. // JAMA: Journal of the American Medical Association;6/22/2005, Vol. 293 Issue 24, p3012 

    Context The global significance of infective endocarditis (IE) caused by Staphylococcus aureus is unknown. Objectives To document the international emergence of health care–associated S aureus IE and methicillin-resistant S aureus (MRSA) IE and to evaluate regional variation in patients...

  • Myocardial uptake of 99mTc-MDP in infective endocarditis. Raza, Hasan; Nasir, Zafar; Kamal, Shahid // Pakistan Journal of Nuclear Medicine;Jun2014, Vol. 3 Issue 1, p78 

    The article presents a case study of a 10-year-old girl who has a congenital heart disease and was diagnosed with infective endocarditis. She was endorsed to a nuclear medicine department for a bone scan to examine a musculoskeletal cause for the pain in her right hip region. She had planar bone...

  • Right-Sided Endocarditis. Williams, David S. // Journal of Insurance Medicine;2012, Vol. 43 Issue 1, p41 

    Right-sided endocarditis is uncommon and usually involves the tricuspid valve. It occurs primarily in intravenous drug uses, and patients having pacemakers, central lines, or congenital heart disease.


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics