Seventy-nine patients underwent valve replacement or repair surgery for active or healed native valve endocarditis between 1976 and 1992. The most common indications for surgery were congestive heart failure (73.4%) and multiple systemic emboli (21.5%). Operative mortality was 3.8% and late mortality was 15.1%. Streptococci were the most common infecting agents (41.8%), followed by Staphylococcus aureus (11.4%). The study assessed the influence of eight preoperative variables on mortality and late valve-related complications, finding that only Staphylococcus aureus infection significantly predicted late valve-related complications. There was no difference in survival or complications between active and

1. Eur J Cardiothorac Surg. 1995;9(6):330-4.
Surgery in native valve endocarditis:indications,resultsand risk factors.
Dodge-KhatamiA,HurniM, RuchatP,StumpeF,Fischer AP,Van Melle G, SadeghiH.
Divisionof CardiovascularSurgery,CHUV Lausanne, Switzerland
Abstract
Seventy-ninepatients(meanage 49years) underwentvalve replacementorrepairforactive (58.2%) or
healed(41.8%) native valve endocarditisbetween1976 and 1992. The most commonindicationfor
surgerywascongestive heartfailure (73.4%),followedbymultiple systemicemboli(21.5%).Emergency
operationwasnecessaryin27.8% of the cases.Operative mortalitywas3.8% (3 patients) andlate
mortality15.1% (12 patients).Streptococci were the mostcommoninfectingagents(41.8%),followed
by Staphylococcusaureus(11.4%).Noorganismswere isolatedin27cases (34.2%).Follow-upspanned
379.8 patient-yearswithamaximumof 15.8 years.Fifteenlate valve-relatedevents(periprostheticleak,
recurrentendocarditis,thrombo-emboliceventsandhemolysis)and20 otherlate complications
(anticoagulant-relatedhemorrhage,arrhythmiasorcongestive heartfailure)occurredin22 patients.
The linearizedrate forall late complicationsis5.8% per patient-year.The influence of eightpreoperative
variablesonoverall mortalityandlate valve-relatedcomplicationswasassessed:age,valve(s) affected,
active or healedinfection,bacteriology,annularabscess,emergencyorelectivesurgery,preoperative
renal functionandNYHA class.OnlyStaphylococcusaureus(P= 0.0012) wasa significantpredictorof
late valve-relatedcomplications.Furthermore,nodifference insurvival orinvalve-relatedcomplications
was foundbetweenthe active andhealedinfections.