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The Journal of Thoracic and Cardiovascular Surgery, Vol 104, 511-520, Copyright © 1992 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
DC McGiffin, AJ Galbraith, GJ McLachlan, RE Stower, ML Wong, EG Stafford, MA Gardner, PG Pohlner and MF O'Brien
Patients (n = 195) undergoing aortic valve replacement (n = 209) for native
or prosthetic valve endocarditis were studied to determine risk factors for
death and recurrent endocarditis and also to determine the valve type least
likely to be associated with recurrent endocarditis. Ten-year survival was
60%, the highest risk of dying occurring within the first 3 postoperative
months. Risk factors for death in this early phase included increased urea
concentration, higher New York Heart Association functional class,
prosthetic valve endocarditis, infection status (lower in patients with
healed endocarditis), longer duration of cardiopulmonary bypass, and nonuse
of an allograft valve. In the late phase (beyond 3 months), risk factors
included age at operation and Staphylococcus aureus infection (only in New
York Heart Association functional class V). Ten years after aortic valve
replacement, 79% of valves were free of recurrent endocarditis. The highest
risk of recurrence was in the first 4 months. Longer duration of
cardiopulmonary bypass was a weak risk factor for recurrent endocarditis in
the early phase, and in the late phase risk factors were S. aureus
infection (only in New York Heart Association functional classes III, IV,
and V) and the use of now discontinued biologic valves. Allograft aortic
valve replacement was shown to be associated with a low and constant risk
of recurrent endocarditis, whereas other valve types were associated with a
high early risk. The allograft valve should be the preferred replacement
device for aortic root infection.
ARTICLES
Aortic valve infection. Risk factors for death and recurrent endocarditis after aortic valve replacement
Department of Cardiac Surgery, Prince Charles Hospital, Brisbane, Queensland, Australia.
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A. S. Bayer, A. F. Bolger, K. A. Taubert, W. Wilson, J. Steckelberg, A. W. Karchmer, M. Levison, H. F. Chambers, A. S. Dajani, M. H. Gewitz, et al. Diagnosis and Management of Infective Endocarditis and Its Complications Circulation, December 22, 1998; 98(25): 2936 - 2948. [Full Text] [PDF]
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B. G. French, K. Wilson, M. Wong, S. Smith, and M. F. O'Brien RIFAMPICIN ANTIBIOTIC IMPREGNATION OF THE ST. JUDE MEDICAL MECHANICAL VALVE SEWING RING: A WEAPON AGAINST ENDOCARDITIS J. Thorac. Cardiovasc. Surg., August 1, 1996; 112(2): 248 - 252. [Abstract] [Full Text]
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A. K. Agnihotri, D. C. McGiffin, A. J. Galbraith, and M. F. O'Brien THE PREVALENCE OF INFECTIVE ENDOCARDITIS AFTER AORTIC VALVE REPLACEMENT J. Thorac. Cardiovasc. Surg., December 1, 1995; 110(6): 1708 - 1724. [Abstract] [Full Text]
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S. F. Aranki, D. H. Adams, R. J. Rizzo, G. S. Couper, T. E. Sullivan, J. J. Collins Jr, and L. H. Cohn Determinants of Early Mortality and Late Survival in Mitral Valve Endocarditis Circulation, November 1, 1995; 92(9): 143 - 149. [Abstract] [Full Text]
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K. Gall, S. Smith, C. Willmette, M. Wong, and M. O'Brien Allograft heart valve sterilization: A six-year in-depth analysis of a twenty-five-year experience with low-dose antibiotics J. Thorac. Cardiovasc. Surg., September 1, 1995; 110(3): 680 - 687. [Abstract] [Full Text]
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 G. McLachlan and D. McGiffin On the role of finite mixture models in survival analysis Statistical Methods in Medical Research, October 1, 1994; 3(3): 211 - 226. [PDF]
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M. Albertucci, K. Wong, M. Petrou, A. Mitchell, J. Somerville, S. Theodoropoulos, and M. Yacoub The use of unstented homograft valves for aortic valve reoperationsReview of a twenty-three-year experience J. Thorac. Cardiovasc. Surg., January 1, 1994; 107(1): 152 - 161. [Abstract] [Full Text]
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