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1 From the Divisions of Adult Cardiology and Critical Care Medicine, Department of Medicine, Cook County Hospital, Chicago; and the Department of Medicine, the University of Illinois at Chicago
2 From the Divisions of Adult Cardiology and Critical Care Medicine, Department of Medicine, Cook County Hospital, Chicago
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.
Key Words: endocarditis • endocarditis-treatment • infective endocarditis-surgery • substance abuse-intravenous-complications
Submitted on September 12, 1994
Accepted on December 16, 2007
This article has been cited by other articles:
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  A. Wahba and D. Nordhaug What are the long-term results of cardiac valve replacements in left sided endocarditis with a history of i.v. drug abuse? Interactive CardioVascular and Thoracic Surgery, October 1, 2006; 5(5): 608 - 610. [Abstract] [Full Text] [PDF]
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