Materials and methods: Retrospective nation-wide study of pa­­tients that underwent open-heart surgery for infective endocarditis at Landspitali University Hospital in 1997-2013. Variables were collected from hospital charts. Long-term survival was analysed using Kaplan- Meier methods. Mean follow-up time was 7.2 years.

Results: Out of 179 patients diagnosed with endocarditis, 38 (21%) ­underwent open heart surgery. Two patients were excluded due to missing information leaving 36 patients for analysis. The number of operations steadily increased, or from 8 to 21 during the first and last 5-years of the study period (OR: 1.12, 95% CI: 1.05-1.21, p=0.002). The most common pathogen was S. aureus and 81% (29/36) of the patients had positive blood cultures. Three patients had history of previous cardiac surgery and five had history of intravenous drug abuse. The aortic valve was most often infected (72%), followed by the mitral valve (28%). The infected valve was replaced in 35 cases 14 with a mechanical prosthesis and 20 with a bioprosthesis. In addition two mitral valves were repaired. Postoperative complications included perioperative myocardial infarction (35%), respiratory failure (44%) and reoperation for bleeding (25%). Thirty-day mortality was 11% (4 patients) with 5- and 10-year survival of 59% and 49%, respectively.

Conclusion: One out of five patients with endocarditis underwent surgery, most commonly aortic or mitral valve replacement. Outcomes were comparable to other studies. In comparison to elective valve replace­ment surgery the rate of post-operative complications and 30-day mortality were higher and long-term survival was less favorable.

Table I, Table II, Table III, Table IV, Table V, Table VI, Figure 1, Figure 2