Endocardite infecciosa valvar submetida a tratamento cirúrgico: análise de 64 casos

Abstract

Objective: To identify some aspects of infective valve endocarditis treated by heart surgery, as well as antibiotic therapy, in a public hospital in the city of Fortaleza, Ceará state, Brazil, from 1988 to 2003. Method: A retrospective and observational study was performed of 64 patients with infective valve endocarditis who required aortic and/or mitral valve replacement, tricuspid vegectomy and repair or pulmonary valve valvulectomy, as well as antibiotic therapy, during their in-hospital stay. They were analyzed in respect to gender, age, time elapsed from hospital admission to the surgery, time elapsed from hospital admission to hospital discharge, valve lesion, blood culture result, surgical treatment and mortality. Results: Infective valve endocarditis treated by heart surgery was more frequent in the third decade of life. Most of patients (81.2%) were males. The patients who died spent a shorter time from hospital admission to the surgery than the patients who survived. The aortic valve was affected in 65% of cases. Positivity blood cultures were seen in 42% and Staphylococcus aureus was isolated in 52.4% of these cases. Valve replacement was necessary in 93.7% of cases. The in-hospital mortality rate was 14.1% which was not influenced by the age of the patient or the blood culture result. Conclusion: Infective valve endocarditis treated by heart surgery was more frequent in men and in the third decade of life. It mostly affected the aortic valve. Staphylococcus aureus was the more common pathogen found. Almost all the patients needed replacement of the infected valve and the in-hospital mortality rate was 14.1%.

<![CDATA[<B>Infective valve endocarditis treated by surgery</B>: <B>analysis of 64 cases</B>]]>

“…However, in this work, in respect to the gender and age, the disease was four times more frequent in men and there was a higher rate in the third decade of life, not disagreeing in this aspect to previously published reports on infective endocarditis, independently of the conduct adopted [7,8]. The higher numbers for men, at least in operated patients, is similar to previous research [8,9] confirming the greater involvement of the male population. In respect to the age range, our study differs in relation to a tendency, described in the North-American literature, of an increase in the mean age [1].…”

“…The low positivity of blood cultures with the identification of microorganisms in only 42% of the cases is a common fact in the medical practice for whom works with infective endocarditis [6,8,9]. Several explanations may exist.…”

Experience of treatment of prosthetic valve endocarditis: a retrospective single-center cross-sectional study

“…This was concordant with previous studies that have mentioned that these valves are the ones predominantly affected by the infectious process. 13,17 Mechanical and biological valves were similarly involved, which is also consistent with previous findings. 18 Our study found that the positivity rate among the blood cultures was low (18.8%).…”

“…19 Taking into account studies conducted in Brazil, the frequency of negative blood cultures ranges from 40% to 58%. 13,15,17,20 Among these studies, only…”

“…5 Brazilian studies have reported overall mortality rates ranging from 14% to 40%. 13,15,17 The present study sought to establish echocardiographic findings and factors associated with the initial operation (Tables 1 and 2) that could characterize risk factors for mortality, but no statistically significant independent risk factors were identified. This was probably due to the small number of events.…”