Results of surgical treatment for infective endocarditis in intravenous drug users.

Abstract

OBJECTIVE: To determine the early and late results of surgical treatment for infective endocarditis (IE) in intravenous drug users (IVDU). DESIGN: Cohort study of consecutive IVDUs undergoing surgical treatment for IE. SETTING: Large public hospital serving the urban population of Chicago, Ill. PATIENTS: Consecutive IVDUs operated on between July 1982 and June 1991 for IE. MAIN OUTCOME MEASURES: Death, stroke, noncerebral systemic embolization, major bleeding, recurrent endocarditis, and repeated valve replacement. RESULTS: There were 80 patients, 58 men and 22 women, with a mean age of 37.5 +/- 10 (SD) years. The hospital course in all patients and follow-up data on 75 (94%) patients were complete. The primary indication for surgery was acute congestive heart failure in 44 (56%), persistent sepsis in 21 (26%), and multiple systemic embolization in 15 (19%) patients. Six patients (7.5%) died within 30 days of surgery. An additional 13 of 69 patients (17.6%) died during the follow-up, 8 from cardiovascular causes. The probability of survival at 36 months and at 60 months was 0.74 +/- 0.05 (SE) and 0.70 +/- 0.05, respectively. Seventeen (30%) of the survivors had at least one major cardiovascular event; 6 (8.8%) had recurrent endocarditis, 4 (5.8%) had stroke, 3 (4.4%) had extracerebral bleeding, 1 had extracerebral systemic embolism, and 3 (4.4%) required repeated valve replacement. Probability of event-free survival at 36 months and 60 months was 0.65 +/- 0.06 and 0.52 +/- 0.08, respectively. The median duration of event-free survival was 65 months. CONCLUSION: Since the expected mortality without surgery in patients with IE in whom medical treatment fails is almost 100%, it is concluded that surgical treatment is indicated for, and substantially improves the outlook for early and late survival of, IVDUs with IE who fail to respond to medical management.