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J Thorac Cardiovasc Surg 2009;138:69-75
© 2009 The American Association for Thoracic Surgery

Acquired Cardiovascular Disease

Outcomes of double valve surgery for active infective endocarditis

Division of Cardiovascular Surgery, Toronto General Hospital, Toronto, Ontario, Canada

Received for publication June 30, 2008; revisions received October 13, 2008; accepted for publication November 22, 2008.

^_* Address for reprints: Christopher M. Feindel, MD, Division of Cardiovascular Surgery, Toronto General Hospital, 200 Elizabeth St, 4N-480, Toronto, Ontario, M5G 2C4, Canada. (Email: Chris.Feindel{at}uhn.on.ca).

Objective: In active infective endocarditis the need for operating simultaneously on the aortic and mitral valves is frequent. There are no studies in the literature documenting long-term outcomes of double valve surgery for active endocarditis.

Methods: Ninety patients underwent double valve surgery for active endocarditis over a 26-year period (mean age, 53 ± 16 years; 71% male patients). Prosthetic endocarditis was seen in 32 patients. Staphylococcus species was isolated in 29%. Forty-six (51%) patients had abscesses. Surgical intervention consisted of valve repair or replacement with limited infection or radical resection, patch reconstruction, and valve replacement for abscesses. Mean follow-up was 5.9 ± 4.7 years (range, 0–18 years) and was complete.

Results: There were 14 (15.6%) in-hospital deaths and 29 (32.2%) late deaths. Overall survival at 5, 7, and 10 years was 68% ± 5%, 59% ± 6%, and 49% ± 6%, respectively, and was reduced in those undergoing operations for prosthetic compared with native endocarditis (7-year survival, 39% ± 9% vs 71% ± 7%; P < .001). Freedom from recurrent endocarditis was 84% ± 5% at 10 years. Freedom from reoperation was 91% ± 4% at 10 years. Event-free survival at 7 and 10 years was 60% ± 6% and 47% ± 7%, respectively. No difference was observed between the native and prosthetic groups for recurrent endocarditis, late reoperation, or event-free survival. Prosthetic endocarditis, increasing age, preoperative shock, and diabetes mellitus were independent predictors of death from all causes.

Conclusions: Double valve surgery for active endocarditis remains technically challenging and associated with significant morbidity and mortality perioperatively and in the longer term. Outcomes are worse in those who have prosthetic valve endocarditis.