Combined Medical and Surgical Treatment for Active Native Valve Infective Endocarditis: Ten-Year Experience

The ai m of this study w as to de termine the beneficial effect and outcome of active native valve infective endocarditis treated with combined medical and surgical treatment. This retrospective review involves 66 patients who have undergone operation for the diagnosis of active native valve infective endocarditis between January ı 98S and June ı 999. They were treated with antibiotic therapy before and after surgical procedure. The aortic valve the mitral valve and were each involved in 18 patients (27%) and both valves in 30 patients (4S.6%). Follow-up averaged 4 ± 3.4 years (range, 2 month to 12 years) and totaled 274. ı patients-years. The operative mortality was ı 2% w ith eight patients. The significant risk factors of early mortality were urgent operation, annular abscess, and preoperative shock. Late mortality was 10.3% with 6 patients. 2 patients (4%) required a subsequent reoperation. Actuarial survival was 80.S% ± S.So/o at S years and 64.7% ± 9.So/o at 10 years. Actuarial freedoru from recurrent infection was 94% ± 4.2S% at S years and 80.44% ± 9.79% at 10 years. Although surgical treatment of native valve endocarditis is still associated with substantial mortality, the long-term outcome of hospital survivors is excellent. In active native valve infective endocarditis without severe complications, the optimal time for surgery is the end of antibiotic therapy. Combined medical and surgical treatment for active native valve infective endocarditis is associated with an improved survival.