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Long-term outcomes in valve replacement surgery for infective endocarditis
Scott P Kaiser1, Spencer J Melby, Andreas Zierer
1Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine/Barnes Jewish Hospital, St. Louis, Missouri 63110, USA.
The Annals of Thoracic Surgery
|December 23, 2006
Summary
Patients with a history of intravenous drug use (IVDU) undergoing surgery for infective endocarditis had similar long-term survival but a higher reoperation rate. This highlights the need to consider life span when choosing prosthetic valves for IVDU patients.
Area of Science:
- Cardiology
- Cardiac Surgery
- Infectious Diseases
Background:
- Infective endocarditis carries a high mortality risk.
- Intravenous drug use (IVDU) increases risk for infective endocarditis.
- Surgical outcomes for IVDU patients with infective endocarditis are underreported.
Purpose of the Study:
- To evaluate surgical treatment outcomes for infective endocarditis in patients with a history of IVDU.
- To compare perioperative and long-term outcomes between IVDU and non-IVDU populations.
Main Methods:
- Retrospective analysis of cardiac surgeries for infective endocarditis (1986-2005).
- Logistic regression used to identify predictors of operative mortality.
- Comparison of outcomes between IVDU and non-IVDU groups.
Main Results:
- IVDU patients were younger at surgery (39 vs. 54 years).
- Overall operative mortality was 12%.
- Long-term survival was similar between groups after age adjustment, but IVDU patients had a higher reoperation rate (17% vs. 5%).
Conclusions:
- IVDU patients with infective endocarditis require reoperation more frequently.
- Long-term survival is comparable between younger IVDU and older non-IVDU patients.
- Prosthetic valve selection should consider anticipated lifespan in IVDU patients.
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