Abstract: This retrospective review from the Cleveland Clinic details the outcomes of 428 patients surgically treated for native (58%) and prosthetic valve (42%) endocarditis over a 5-year period [1Manne M.B. Shrestha N.K. Lytle B.W. et al.Outcomes after surgical treatment of native and prosthetic valve infective endocarditis.Ann Thorac Surg. 2012; 93: 489-494Abstract Full Text Full Text PDF PubMed Scopus (95) Google Scholar]. Two thirds of the patients lived in Ohio and one third came from other states or countries. Only 24 patients (5.6%) were active intravenous drug users. The majority of patients admitted with endocarditis to this facility underwent surgical treatment, which would suggest a degree of chronicity of the infection and infers prolonged antibiotic therapy there or elsewhere. In patients with native valve endocarditis approximately one third involved the aortic valve, one third involved the mitral valve, and the remaining one third had right-sided valve involvement or multiple valve involvement. The chronicity of the infection is suggested by the high frequency of valvular insufficiency in this group. In patients with prosthetic endocarditis, two thirds had infected aortic prosthesis and one third had mitral valve prosthetic infections or multiple valve involvement. Staphylococcus aureus was the most common causative agent, followed by coagulase-negative Staphylococcus organisms. The operative mortality was 6.5% for native valve endocarditis and 16% for prosthetic valve endocarditis, and at 1 year the mortality was 18% and 23%, respectively. Interestingly these figures were significantly higher in those patients with staphylococcal infection. The patients remained in the hospital for approximately 3 weeks. These excellent results reflect some of the surgical principles outlined in the article and are particularly noteworthy. These include a radical debridement of all infected tissue, generous irrigation, the use of allografts for root replacement when the aortic annulus is involved, the use of autologous pericardium for buttress material, and avoidance of prosthetic grafts or foreign material and biological glues. Aortic allografts were used in 173 patients, biological valves in 187 patients, and mechanical valves in 45 patients. Regrettably, the outcomes were not stratified by the type of prosthesis or allograft used. It is easy to speculate that aggressive and complete debridement followed by reconstruction accounts for these excellent results. The majority of patients treated for native and prosthetic valve aortic endocarditis received allograft root replacement (173/282 patients). This is very noteworthy and should encourage the use of this reconstruction when annular involvement is present. Adoption of these principles will improve survival in patients surgically treated for endocarditis. Outcomes After Surgical Treatment of Native and Prosthetic Valve Infective EndocarditisThe Annals of Thoracic SurgeryVol. 93Issue 2PreviewThe risk of death and complications of infective endocarditis (IE) treated medically has to be balanced against those from surgery in constructing a therapeutic approach. Recent literature has drawn conflicting conclusions on the benefit of surgery for IE. We reviewed patients treated surgically for IE at the Cleveland Clinic from 2003 to 2007 to examine their outcomes. Full-Text PDF