XXXX after @entity299 . Impact upon survival.

@entity1 @entity75 @entity1764 @entity177 @entity281 @entity299 @entity583 @entity340 @entity3555 @entity884
@entity1764 after cardiac valve replacement is a dreaded complication with consequent mortality estimated as high as 70%. We have reviewed 2,491 @entity1 with @entity299 to assess the impact of @entity1764 upon mortality in our institution in the past 10 years. @entity1764 developed after valve replacement in 36 @entity1 (1.4%). All @entity1 required operative intervention for @entity281 with positive bacterial cultures. Twelve of these @entity1 had other perioperative problems associated with a high mortality independent of @entity1764 : @entity3555 not cured by valve replacement (three), recent preoperative @entity583 (four), @entity340 with @entity177 (one), and severe perioperative @entity75 (four). Ten of these high-risk @entity1 died (83.3%). The impact of @entity1764 upon survival is best evaluated in the remaining 24 @entity1 without high-risk perioperative problems. Eight of these @entity1 were managed before 1980 with d  bridement and irrigation as the primary treatment, with two hospital deaths (25%). Pectoral or rectus muscle flaps were frequently used after 1980 (flaps in 11 of 16 @entity1 ), leading to a significantly shorter time between diagnosis of @entity281 (62 versus 385 days, p less than 0.05). Only one of these 16 @entity1 died. Valve re-replacement for @entity884 was performed in three of these 24 @entity1 although 13 of 24 had positive blood cultures. @entity1764 after valve operations in the absence of other high-risk perioperative problems can be successfully managed. Early d  bridement and muscle flap closure has led to a 94% survival rate in 16 @entity1 during the past 4 years.
