Valve replacement for native valve endocarditis.

Over a 10-year period (1972-1981) 40 valves were replaced in 35 patients with native valve endocarditis. Hospital mortality was 17 per cent (6/35). Long-term follow-up is current in 27 of 29 survivors. Twenty-three of these patients are alive with a mean follow-up of 44.7 months (11-91 months) and an overall survival of 70 per cent. Eighty-seven per cent of the long-term survivors are New York Heart Association (NYHA) Class I or II. In our series, anular or myocardial abscess was an ominous finding; only 25 per cent (2/8) of these patients were alive at long-term follow-up. When abscess was not present, early operation (less than 4 weeks of preoperative antibiotic therapy) was associated with better long-term survival (91%) than was late operation (greater than 4 weeks of preoperative antibiotic therapy, 79%).