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The Journal of Thoracic and Cardiovascular Surgery, Vol 90, 676-680, Copyright © 1985 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
MS Sweeney, GJ Reul Jr, DA Cooley, DA Ott, JM Duncan, OH Frazier and JJ Livesay
The choice between bioprosthetic or mechanical prosthetic valve replacement
for active valvular endocarditis has been controversial. To establish the
role of each, we reviewed the case histories of 185 patients who underwent
valve replacement for active valvular endocarditis during the past 5 years.
All patients had life- threatening, active bacterial endocarditis of a
native or prosthetic valve. Group I (88 patients) had replacement with the
Ionescu-Shiley pericardial valve and Group II (97 patients) with the St.
Jude Medical valve. The male/female distribution, age range, and functional
classification were the same in the two groups. Mean follow-up was
approximately 20 months for both groups. Valve replacement was done because
of native valve endocarditis in 76 patients in Group I and 49 patients in
Group II. Of the remainder of the Group I patients, six had endocarditis of
a bioprosthesis and six of a mechanical valve; of the remainder of Group II
patients, 30 had endocarditis of a bioprosthesis and 18 of a mechanical
valve. Early mortality was not significantly different between the two
groups (14 deaths in each group). Of the 74 survivors in Group I, 15
underwent valve reoperation, 10 because of recurrent endocarditis and five
because of sterile perivalvular leakage. The frequency of reoperation was
significantly different (p less than 0.01) from that in Group II, in which
only five patients underwent valve reoperation, four for recurrent
endocarditis and one for sterile perivalvular leakage. The actuarial rate
for freedom from reoperation was also significantly higher in Group II
patients; 94.6% were free from reoperation at 4 years compared to 75% at 4
years in Group I patients (p less than 0.01). The actuarial survival rate,
which also differed significantly between groups, was 78.7% at 4 years in
Group I and 87.4% at 4 years in Group II (p less than 0.05). Patients
receiving a bioprosthesis for active endocarditis had a significantly
higher reoperation rate and a significantly greater incidence of recurrent
endocarditis (p less than 0.01). Therefore, we prefer to use a mechanical
valve for valve replacement in most patients who have active endocarditis.
ARTICLES
Comparison of bioprosthetic and mechanical valve replacement for active endocarditis
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