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Long Term Outcome of Patients Undergoing Reintervention for Infective Endocarditis
Francesca Chiaramonti, Marco Solinas, Federica Marchi, Andrea Farneti, Sergio Berti, Enkel Kallushi, Tommaso Gasbarri, Mattia Glauber.
Heart Hospital G. Pasquinucci, Massa, Italy.

OBJECTIVE Infective endocarditis (IE) are still a complication that affects the outcome of patients who undergo cardiac surgery. When IE occur is often required a reintervention.This study aimed to examine the outcome of patients undergoing reoperation for IE. METHODS From November 2001 to February 2013, 86 patients underwent reintervention for IE in our center. The first operation was an isolated mitral procedure (repair/replacement) in 13 patients, an isolated aortic procedure in 20 pts, an aortic replacement combined with a mitral procedure in 17 pts, a CABG combined with a valvular procedure in 16 patients and a complex operations in 20 pts. Thirty-two (37%) patients was female. Mean age was 67,64 ± 12,85 and mean Logistic euroSCORE was 34,88 ± 22,25. The time between the first and second intervention was 149,95 ± 65,33 months. In 13 cases first operation was performed through a minimally invasive approach. RESULTS Overall in-hospital mortality was 19% (16). In two patients death was intraoperative. In 13 (81%) cases death was due to low cardiac output related to sepsis; two (13%) patients had a stroke, and one (6%) patient had an abdominal hemorrhage. The mitral valve was involved to IE in 7 (44%) patients who died in perioperative period. Mean cardiopulmonary bypass time and mean aortic cross clamp time was 205,92 ± 86,17 minutes and 136,06 ± 71,83 minutes. Mean Intensive Care Unit stay was 4,27 ± 5,64 days. Survival at 1 year, 5-years and 10-years were 63%, 55% and 48% respectively. Reoperation-free survival was 99%; in one patients, ten years after first operation, was performed a Valve-in-Valve procedure with a Edwards Sapien Valve due to bioprosthesis degeneration. Follow up was completed of 85%; median follow up time was 22 months (range 0-139 months). CONCLUSIONS In our experience redo surgery for IE is more frequently in patients the previously had a combined procedure. The reoperations for IE are challenging for the surgeon and the in-hospital mortality rate is very high due to the underlying disease condition. Mitral valve IE is related to a higher risk of perioperative death. In survivors the freedom from IE recurrence is excellent.

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