Table 3. Selected references regarding surgical technique and operative outcomes in infective endocarditis.
| Author | Year | Design, use of database, study period, valve evaluated | Patient and operative profile | Method of reconstruction | Outcome | Comment |
|---|---|---|---|---|---|---|
| Savage et al. (33) | 2014 | Retrospective, STS ACSD, 2005–2011, primary (n=8,421) and re-operative (n=3,139) cases of IE involving the aortic valve undergoing mechanical vs. stented biologic vs. homografts | Biologic patients were older with more DM, HLD, HTN, Class III/IV HF | Valve replacement, vs. root replacement with valve conduit vs. other (repair, root without valve etc.) | Adjusted mortality higher in root replacement compared to valve replacement (OR 1.43). Homografts worse mortality compared to biologic (OR 1.37). Unadjusted mortality for primary vs. re-operative: 9.8 vs. 21.1% | Use of biologic increasing over time across all cases, with mechanical and homograft decreasing in both primary and re-operative cases. Homografts used mostly in re-operations |
| Mayer et al. (36) | 2011 | Retrospective, single institution, 2000–2009, 100 cases of aortic IE | 31 cases in ICU preoperatively. Replacement patients older with significantly higher EuroSCORE. CBP and cross-clamp time similar | Repair (33%) vs. replacement (67%) (biologic, mechanical, Ross) | Early mortality and morbidity similar (9% vs. 18%, P=0.37). Survival at 4 years better after repair (44% vs. 65% P=0.047). Re-operation more frequent after repair (only in >1 cm patches) | AR more frequent in repair than replacement (P=0.066) |
| Kim et al. (37) | 2016 | Retrospective propensity-matched, 2 tertiary referral institutions, 2002–2014, 304 adults with active IE | Xenograft patients oldest followed by homograft and mechanical. DM, smoking and class III/IV HF similar | Homograft (28.3%) vs. mechanical (26%) vs. xenograft (45.7%) | After risk adjustment, early (19.8% vs. 12.7% vs. 7.2%) & long-term mortality (26.7%vs. 19.0% vs. 15.8%) or valve-related complications similar. Homograft did not affect reinfection rate | Risk factor for early & late mortality: IDDM, elevated Cr, MRSA, multivalve IE, PVE, IABP, and root replacement. Risk factor for reinfection: current IVDU, multivalve IE, severe valvular dysfunction. Homograft not associated with reinfection |
| Lee et al. (38) | 2018 | Retrospective, Taiwanese national research database, 2000–2013, 1,999 cases of MV surgery for IE. 352 propensity-matched patients in the final analysis | Repair vs. replacement had similar baseline characteristics | MV replacement (78.8%) vs. repair (21.2%) | Repair had lower in-hospital mortality (6.3% vs. 10.8%. P=0.031), lower late mortality (HR 0.67, 95% CI, 0.52–0.7), fewer strokes, transfusions | The beneficial effect of repair was less apparent in hospitals with low volume. Among patients with active IE, MV repair had lower all-cause mortality |
STS, society of thoracic surgeons; ACDS, adult cardiac surgery database; IE, infective endocarditis; DM, diabetes mellitus; HLD, hyperlipidemia; HTN, hypertension; HF, heart failure; OR, odds ratio; CBP, cardio-pulmonary bypass; NVE, native valve endocarditis; PVE, prosthetic valve endocarditis; IDDM, insulin-dependent DM; IABP, intra-aortic balloon pump; MV, mitral valve.