Long-Term Outcomes in Valve Replacement Surgery for Infective Endocarditis

Scott P. Kaiser, Spencer J. Melby, Andreas Zierer, Richard B. Schuessler, Marc R. Moon, Nader Moazami, Michael K. Pasque, Charles Huddleston, Ralph J. Damiano, Jennifer Lawton

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)30-35
Number of pages6
JournalAnnals of Thoracic Surgery
Volume83
Issue number1
DOIs
StatePublished - Jan 2007
Externally publishedYes

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Endocarditis
Pharmaceutical Preparations
Population
Reoperation
Survival
Mortality
Thoracic Surgery
Retrospective Studies
Age Groups
Logistic Models

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Kaiser, S. P., Melby, S. J., Zierer, A., Schuessler, R. B., Moon, M. R., Moazami, N., ... Lawton, J. (2007). Long-Term Outcomes in Valve Replacement Surgery for Infective Endocarditis. Annals of Thoracic Surgery, 83(1), 30-35. https://doi.org/10.1016/j.athoracsur.2006.07.037

Long-Term Outcomes in Valve Replacement Surgery for Infective Endocarditis. / Kaiser, Scott P.; Melby, Spencer J.; Zierer, Andreas; Schuessler, Richard B.; Moon, Marc R.; Moazami, Nader; Pasque, Michael K.; Huddleston, Charles; Damiano, Ralph J.; Lawton, Jennifer.

In: Annals of Thoracic Surgery, Vol. 83, No. 1, 01.2007, p. 30-35.

Research output: Contribution to journalArticle

Kaiser, SP, Melby, SJ, Zierer, A, Schuessler, RB, Moon, MR, Moazami, N, Pasque, MK, Huddleston, C, Damiano, RJ & Lawton, J 2007, 'Long-Term Outcomes in Valve Replacement Surgery for Infective Endocarditis', Annals of Thoracic Surgery, vol. 83, no. 1, pp. 30-35. https://doi.org/10.1016/j.athoracsur.2006.07.037
Kaiser, Scott P. ; Melby, Spencer J. ; Zierer, Andreas ; Schuessler, Richard B. ; Moon, Marc R. ; Moazami, Nader ; Pasque, Michael K. ; Huddleston, Charles ; Damiano, Ralph J. ; Lawton, Jennifer. / Long-Term Outcomes in Valve Replacement Surgery for Infective Endocarditis. In: Annals of Thoracic Surgery. 2007 ; Vol. 83, No. 1. pp. 30-35.
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AU - Kaiser, Scott P.

AU - Melby, Spencer J.

AU - Zierer, Andreas

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AU - Moon, Marc R.

AU - Moazami, Nader

AU - Pasque, Michael K.

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AU - Damiano, Ralph J.

AU - Lawton, Jennifer

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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.

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