We describe 30 cases (1.7%) of community-acquired penicillin-susceptible Streptococcus agalactiae endocarditis among 1771 episodes of endocarditis diagnosed in 4 Spanish hospitals from 1975 through 1998. Endocarditis affected a native valve (most often the mitral valve) in 25 cases (83%). Surgical valve replacement was performed for 12 patients (40%). Fourteen patients (47%) died. Mortality rates for patients with native and prosthetic valve endocarditis were 36% and 100%, respectively (P=.01). The mortality rate for native valve endocarditis decreased during the last 6 years of the study (from 61% in 1975-1992 to 8% in 1993-1998; P<.05). Additionally, 115 cases in the literature from 1962-1998 were reviewed. During 1980-1998, the percentage of patients who underwent cardiac surgery increased from 24% (in the previous period, 1962-1979) to 43% (P=.05) and the mortality rate decreased from 45% to 34% (P=NS). S. agalactiae is an uncommon cause of endocarditis with a high mortality rate, although the prognosis of native valve endocarditis has improved in recent years, probably because of an increased use of cardiac surgery.

Survival after infective endocarditis is fair (81% probability of survival at 10 years), and the most common types of cardiac death are sudden and postoperative. Aortic valve involvement is an independent predictor of the need for late cardiac surgery. The rate of recurrences is not negligible (incidence density at 15 years, 0.0030 per patient-year).

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One hundred and ninety-four episodes of endocarditis on native valves in non-addict patients were diagnosed from 1975 to 1992 and were divided into groups A (78 patients, 1975-1983) and B (116 patients 1984-1992). Both groups had the same gender distribution, similar valvular involvement and microbiological characteristics. In group B patients, median age was older (46 vs 54 years, P = 0.0002), the number of patients without previous heart disease was higher (46% vs 22%, P = 0.02) and the median time of symptoms before diagnosis was shorter (30 vs 50 days, P = 0.038). Both groups had similar incidence of heart failure (32% vs 36%), surgical treatment (30% vs 33%) and embolic episodes (26% vs 34%). Surgical mortality decreased from 43% to 18% (P = 0.03). Overall mortality decreased non-significantly from 19% in group A to 12% in group B. Predictors of death in group A were heart failure (odds ratio 9.6, 95% confidence interval 3-36) and surgical treatment (odds ratio 5, 95% confidence interval 1.3-19). Predictors of death in group B were age (odds ratio 4.98, 95% confidence interval 1.4-19), female sex (odds ratio 5.3, 95% confidence interval 1.3-20), staphylococcal infection (odds ratio 4.9, 95% confidence interval 1.1-22) and heart failure (odds ratio 5.2, 95% confidence interval 1.3-20). Although in recent years infective endocarditis occurs in older patients and is more common in patients with previously unknown heart disease a substantial change in major clinical and prognostic variables is not apparent in our population. Overall in-hospital mortality has decreased from 19% to 12% mainly due to better surgical results.

Objective-To analyse the long term results of mechanical prostheses for treating active infective endocarditis. Design-Prospective cohort study of a consecutive series of patients diagnosed with infective endocarditis and operated on in the active phase of the infection for insertion of a mechanical prosthesis. Setting-Tertiary referral centre in a metropolitan area. Results-Between 1975 and 1997, 637 cases of infective endocarditis were diagnosed in the centre. Of these, 436 were left sided (with overall mortality of 20.3%). Surgical treatment in the active phase of the infection was needed in 141 patients (72% native, 28% prosthetic infective endocarditis). Mechanical prostheses were used in 131 patients. Operative mortality was 30.5% (40 patients). Ninety one survivors were followed up prospectively for (mean (SD)) 5.4 (4.5) years. Thirteen patients developed prosthetic valve dysfunction. Nine patients suVered reinfection: four of these (4%) were early and five were late. The median time from surgery for late reinfection was 1.4 years. During follow up, 12 patients died. Excluding operative mortality, actuarial survival was 86.6% at five years and 83.7% at 10 years; actuarial survival free from death, reoperation, and reinfection was 73.1% at five years and 59.8% at 10 years. Conclusions-In patients surviving acute infective endocarditis and receiving mechanical prostheses, the rate of early reinfection compares well with reported results of homografts. In addition, prosthesis dysfunction rate is low and long term survival is good. These data should prove useful for comparison with long term studies, when available, using other types of valve surgery in active infective endocarditis. (Heart 2001;86:63-68) Keywords: infective endocarditis; surgery; mechanical prosthesisThe diagnosis and treatment of infective endocarditis has evolved greatly in recent years. Nevertheless, the morbidity and mortality of this disease remains high.1-4 Initially, medical treatment with an eVective antibiotic is mandatory. If the disease progresses or heart failure symptoms develop because of valve disruption, surgery should be considered. [5][6][7][8][9] Thus the surgical treatment must often be performed in the active phase of the infection. The best timing for the operation and the preferred surgical technique are matters of debate. The most controversial points are the optimal device for the valve replacement and the long term results of such surgery.Our aim in this study was to analyse the long term results of mechanical prostheses for the treatment of active infective endocarditis in our institution during a 22 year period. We report a large prospective series with standardised preoperative management, surgical indications, and long term follow up. Methods PATIENTSAll patients diagnosed with infective endocarditis at our institution between 1975 and 1997 were included in the study. The infectious diseases department supervises all blood cultures taken in our institution on a daily basis in the microbiology laborato...