Long-term results after operations for active infective endocarditis in native and prosthetic valves

Ann Thorac Surg. 2012 Oct;94(4):1204-10. doi: 10.1016/j.athoracsur.2012.04.093. Epub 2012 Jul 7.


Background: The objective of this study was to evaluate the midterm results of patients who underwent operations for active infective endocarditis.

Methods: Within a 10-year period, 141 patients with active infective endocarditis received surgical therapy. We assessed outcome, freedom from reinfection, and freedom from reintervention. Prosthetic valve endocarditis was included in this series.

Results: Surgical strategies included valve replacement with a tissue valve in 62% of patients and valve repair in 29% of patients. In 29% of patients, reconstruction of the aortomitral continuity, left ventricular outflow tract, or sinus of Valsalva was preferably performed with 1 or more bovine pericardial patches. In-hospital mortality was 11% and postoperative stroke rate was 7%. Multivariate logistic regression revealed multivalve involvement (p=0.052; odds ratio [OR], 5.84; 95% confidence interval [CI], 0.98-34.57), preoperative neurologic impairment (p=0.006; OR, 9.71; 95% CI, 1.92-49.09), and European system for cardiac operative risk evaluation (EuroSCORE) in quartiles (p=0.023; OR, 2.88; 95% CI, 1.15-7.17) to be independent predictors for in-hospital death. One-year and 5-year actuarial survival was 77% and 69%, respectively. One-year and 5-year actuarial freedom from reinfection was 100% and 90%, respectively. Freedom from reoperation at 5 years was 100%. Five-year survival was 74% for single-valve endocarditis and 46% for multivalve endocarditis (p<0.001). One-year freedom from reinfection was 100% for both single-valve and multivalve endocarditis; 5-year freedom from reinfection was 95% for single-valve endocarditis versus 67% for multivalve endocarditis (p=0.049).

Conclusions: Despite a high early mortality during the first year, surgical intervention for active infective endocarditis provided excellent results with regard to freedom from reinfection and reoperation. A strategy of extensive debridement, reconstruction of destroyed cardiac structures using xenopericardium, followed by valve replacement or repair is highly effective and shows favorable long-term outcomes.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Animals
  • Anti-Bacterial Agents / therapeutic use
  • Cattle
  • Disease-Free Survival
  • Echocardiography
  • Endocarditis / complications
  • Endocarditis / drug therapy
  • Endocarditis / surgery*
  • Female
  • Follow-Up Studies
  • Heart Valve Diseases / diagnostic imaging
  • Heart Valve Diseases / etiology
  • Heart Valve Diseases / surgery*
  • Heart Valve Prosthesis*
  • Humans
  • Male
  • Middle Aged
  • Pericardium / transplantation*
  • Prosthesis Design
  • Time Factors
  • Treatment Outcome


  • Anti-Bacterial Agents