Little information is available about surgical outcomes in patients with multivalvular
endocarditis. The aim of this article is to review the 21-year experience with surgical
treatment of patients with multivalvular endocarditis at our institution and, in particular,
to determine the incidence, pathologic status, diagnosis, surgical strategies, and
outcomes of patients with this disease.
From January 1986 to December 2006, a total of 48 patients (40 men, 8 women), with
a mean age of 42 +/- 12 years, underwent surgery for multivalvular endocarditis. Endocarditis
was active in 32 patients and healed in 16. Preoperative transthoracic echocardiographic
evaluation was performed in all 48 patients with addition of transesophageal echocardiography
in 22 (45.8%). Intraoperative findings showed that the endocarditis involved mostly
the mitral and aortic valves (40/48 patients). Triple or quadruple valve involvement
was found in 1 and 2 patients, respectively. Preoperative, perioperative, and postoperative
data were retrospectively analyzed and risk factors for early and late survival were
determined.
In only 24 (50.0%) patients was multivalvular endocarditis diagnosed by preoperative
transthoracic echocardiography; 17 (77.3%) patients had multivalvular endocarditis
confirmed by preoperative transesophageal echocardiography. The 30-day hospital mortality
was 12.5% (n = 6). Preoperative renal failure, New York Heart Association class IV,
and emergency surgery were identified as independent risk factors for hospital mortality.
Overall long-term survival was 74% +/- 6% at 5 years and 62% +/- 3% at 10 years. Multivariate
analysis revealed that renal failure and recurrent endocarditis were associated with
increased late mortality. Ten-year freedom from recurrent endocarditis was 74% +/-
5% and 10-year freedom from reoperation was 73% +/- 6%.
In our institution, multivalvular endocarditis was diagnosed by transthoracic echocardiography
in only half of the patients. Intraoperative transesophageal echocardiography provided
a more effective means to identify this disease. Radical resection of all infected
tissues for patients with multivalvular endocarditis and additional intraoperative
interventions, depending on the intraoperative pathologic condition, produced satisfactory
in-hospital and long-term results, similar to those in patients with a single infected
heart valve.