Long-term results after surgery for single- and multi-valve active infective endocarditis

Objective: To evaluate our results in patients undergoing surgery for active infective endocarditis.

Methods: Within a 10 year period 141 patients with active infective endocarditis were treated. We assessed treatment modalities, outcome as well as freedom from infection and freedom from reintervention for single-valve-endocarditis (SVE) vs. multi-valve-endocarditis (MVE).

Results: Surgical strategies included biological valve replacement in 62% and valve repair in 29%. In 29% of patients, reconstruction of the aortomitral continuity, LOVT or Sinus of valsalva was preferably performed with one or more bovine pericardial patches. The remaining patients underwent either homograft replacement or combined procedures. One-year survival was 84% (SVE) vs. 46% (MVE); five-year survival was 74% for single vs. 46% for multi-valve-endocarditis (p<0.001). One-year freedom of reinfection was 100% for SVE and MVE; 5-year freedom of reinfection was 95% for single vs. 67% for multi-valve-endocarditis (p=0.049).

Conclusions: Despite a high early mortality during the first year especially in patients with multivalve endocarditis, surgery for active infective endocarditis provides excellent results with regard to freedom from reinfection as well as freedom from reoperation. A strategy of extensive reconstruction of endocarditis-affected cardiac structures in combination with valve replacement or repair is highly effective and may proove favourable results with regard to long-term outcome.