TY - JOUR
T1 - Long-Term Outcomes in Valve Replacement Surgery for Infective Endocarditis
AU - Kaiser, Scott P.
AU - Melby, Spencer J.
AU - Zierer, Andreas
AU - Schuessler, Richard B.
AU - Moon, Marc R.
AU - Moazami, Nader
AU - Pasque, Michael K.
AU - Huddleston, Charles
AU - Damiano, Ralph J.
AU - Lawton, Jennifer S.
N1 - Funding Information:
This research was supported by a grant from the National Institutes of Health F32 HL078136–01(SJM).
PY - 2007/1
Y1 - 2007/1
N2 - Background: Infective endocarditis is associated with a high rate of long-term mortality. Patients with a history of intravenous drug use (IVDU) are at increased risk for infective endocarditis. However, few studies have reported results of surgical treatment on this population. We present 19.5 years of experience with surgically treated patients with infective endocarditis. Methods: A retrospective study of all cardiac surgeries with a diagnosis of infective endocarditis at a single institution from 1986 to 2005 was performed. Logistic stepwise regression with an end point of operative mortality was done. Variables were age, gender, race, history of drug use, previous valve surgery, and previous valve replacement. Perioperative and outcome variables were compared between IVDU and non-IVDU populations. Results: The IVDU population required surgery at a younger age (39 ± 9 years versus 54 ± 15 years; p < 0.001). Overall operative mortality was 12% (41/346). The perioperative complication rate was similar for both groups. When adjusted for age, the two groups had similar long-term survival (p = 0.78). Kaplan-Meier estimator showed that survival at 10 and 15 years was 66% and 54% for IVDU and 56% and 42% for non-IVDU (number at risk, 19, 11, and 61, 28, respectively; p = 0.137). Reoperation for recurrent infective endocarditis was necessary in 9 (17%) of 52 of the IVDU group versus 14 (5%) of 270 of the non-IVDU group (p = 0.03). Conclusions: Patients with a history of IVDU required reoperation for recurrent infective endocarditis at a significantly higher rate than the non-IVDU patients. Long-term survival was similar between the younger IVDU population and the older non-IVDU population. Anticipated life span is one of many factors when considering prosthetic valve choice in this population.
AB - Background: Infective endocarditis is associated with a high rate of long-term mortality. Patients with a history of intravenous drug use (IVDU) are at increased risk for infective endocarditis. However, few studies have reported results of surgical treatment on this population. We present 19.5 years of experience with surgically treated patients with infective endocarditis. Methods: A retrospective study of all cardiac surgeries with a diagnosis of infective endocarditis at a single institution from 1986 to 2005 was performed. Logistic stepwise regression with an end point of operative mortality was done. Variables were age, gender, race, history of drug use, previous valve surgery, and previous valve replacement. Perioperative and outcome variables were compared between IVDU and non-IVDU populations. Results: The IVDU population required surgery at a younger age (39 ± 9 years versus 54 ± 15 years; p < 0.001). Overall operative mortality was 12% (41/346). The perioperative complication rate was similar for both groups. When adjusted for age, the two groups had similar long-term survival (p = 0.78). Kaplan-Meier estimator showed that survival at 10 and 15 years was 66% and 54% for IVDU and 56% and 42% for non-IVDU (number at risk, 19, 11, and 61, 28, respectively; p = 0.137). Reoperation for recurrent infective endocarditis was necessary in 9 (17%) of 52 of the IVDU group versus 14 (5%) of 270 of the non-IVDU group (p = 0.03). Conclusions: Patients with a history of IVDU required reoperation for recurrent infective endocarditis at a significantly higher rate than the non-IVDU patients. Long-term survival was similar between the younger IVDU population and the older non-IVDU population. Anticipated life span is one of many factors when considering prosthetic valve choice in this population.
UR - http://www.scopus.com/inward/record.url?scp=33845495440&partnerID=8YFLogxK
U2 - 10.1016/j.athoracsur.2006.07.037
DO - 10.1016/j.athoracsur.2006.07.037
M3 - Article
C2 - 17184626
AN - SCOPUS:33845495440
SN - 0003-4975
VL - 83
SP - 30
EP - 35
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 1
ER -