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Surgical therapy in patients with active infective endocarditis: seven-year single centre experience in a subgroup of 255 patients treated with the Shelhigh^® stentless bioprosthesis

Deutsches Herzzentrum Berlin, Department of Cardiothoracic and Vascular Surgery, Augustenburger Platz 1, 13353 Berlin, Germany

Received 21 January 2008; received in revised form 27 April 2008; accepted 7 May 2008.

^_* Corresponding author. Tel.: +30 4593 2219; fax: +30 4593 2100. (Email: musci{at}dhzb.de).

Objective: We investigated outcomes after surgical therapy in patients with active infective endocarditis (AIE) with regard to survival in relation to surgical urgency, valve position, number of valves implanted and abscess formation. We aimed to identify independent risk factors for early mortality. Methods and results: Two hundred and fifty-five patients received Shelhigh^® bioprostheses between February 2000 and March 2007. A total of 74.1% had native and 25.9% prosthetic AIE. Surgery was regarded as urgent in 57.3% and as an emergency procedure in 38.4%. There was a highly significant difference in survival rate between patients who were operated on urgently versus in an emergency (p < 0.0001), between single and double valve replacement (p = 0.0206) and between patients with and without abscess formation (p = 0.0245). There were two cases of early reinfection (0.78%) and six of late reinfection (2.35%) leading to re-operation. Conclusions: The survival of patients differs significantly in dependence on their surgical urgency. Better outcome could have been achieved if patients had been referred earlier for surgery and operated upon before heart failure or septic shock developed. Long-term survival was better in patients without abscess formation. The low reinfection rate of Shelhigh^® bioprostheses in AIE is promising and the early and mid-term results achieved need to be verified in the long-term course.

Key Words: Infective endocarditis • Surgery • Bioprosthesis

This article has been cited by other articles:

				S. Gabbay Why are the results reported from this center inconsistant with the general experience of 4000 implants and 10 years of follow-up? J. Thorac. Cardiovasc. Surg., May 1, 2009; 137(5): 1293 - 1294. [Full Text] [PDF]

				M. Musci, H. Siniawski, and R. Hetzer Shelhigh bioprosthesis in active infective endocarditis. J. Thorac. Cardiovasc. Surg., May 1, 2009; 137(5): 1295 - 1296. [Full Text] [PDF]

				T. Carrel, F. S. Schoenhoff, and D. Cameron Reply to the Editor J. Thorac. Cardiovasc. Surg., May 1, 2009; 137(5): 1296 - 1297. [Full Text] [PDF]