Single and Multiple Valve Surgery in Native Valve Infective Endocarditis

Abstract

Background

Surgical treatment of infective endocarditis (IE) remains a challenge, especially in cases of multiple valve surgery. We evaluated the clinical outcomes of native valve IE and compared the outcomes of single valve surgery with those of multiple valve surgery.

Materials and Methods

From 1997 to 2011, 90 patients underwent surgery for native valve IE; 67 patients with single valve surgery (single valve group) and 23 patients with multiple valve surgery (multiple valve group). The mean follow-up duration was 73.1±47.4 months.

Results

The surgical mortality in the total cohort was 4.4%. The overall survival (p=0.913) and valve-related event-free survival (p=0.204) did not differ between the two groups. The independent predictor of postoperative complications was New York Heart Association class (p=0.001). Multiple valve surgery was not a significant predictor of surgical mortality (p=0.225) or late mortality (p=0.936). Uncontrolled infection, urgent or emergency surgery, and postoperative complications were identified as independent predictors of valve-related morbidity, excluding multiple valve surgery (p=0.072).

Conclusion

In native valve IE, multiple valve surgery as a factor was not an independent predictor of mortality and morbidity. The number of surgically corrected valves in native IE seems to be unrelated to perioperative and long-term outcomes.

Keywords: Endocarditis, Heart valves, Thoracic surgery, Mortality, Morbidity

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INTRODUCTION

The incidence of surgical treatment of infective endocarditis (IE) has markedly increased, and the rate of surgical treatment for multiple valve involvement is approximately 70% [1]. Multiple valve IE often has more severe hemodynamic deterioration and extensive tissue destruction, and may need more complex surgical therapy [2].

Many authors have reported on the surgical outcomes of multiple valve IE [3-11]. In their studies, however, prosthetic valve endocarditis was included with native valve endocarditis. Prosthetic valve endocarditis differs from native valve endocarditis in that it has a more difficult diagnosis and surgical strategy, and worse prognosis [12]. Only a few studies have specifically focused on surgical therapy for multiple native valve IE [4,10,11]. We reviewed the surgical outcomes of native valve IE, and compared single valve surgery with multiple valve surgery during the past 15 years in Sejong General Hospital.