Early Surgery for Active Infective Endocarditis Improves Early and Late Results

Abstract

To investigate the timing of surgery in active infective endocarditis, the data of 54 patients, consecutively operated for this reason from September 1973 to May 1989, were analysed. Native valves were involved in 31 patients (57%): the aortic valve in 22, the mitral valve in 6, and both valves in 3 cases. Prosthetic valves were involved in 23 patients (43%): the aortic valve in 14, the mitral valve in 7, and both valves in 2 cases. There were no significant differences between involvement of native or prosthetic valves and mortality, morbidity, or consequences of morbidity. No significant correlation was found between causative microorganism and mortality, morbidity, or consequences of morbidity. The indication for operation was cardiac failure in 15 patients (28%), ongoing infection in 24 (44%) or a combination of these in 15 (28%). Major embolization occurred in 12 patients (22%) and affected women more than men (p = 0.05). Hospital mortality was 8 (15%). Morbidity involved 15 more patients; structural deterioration of the valve prosthesis occurred in 1 patient; nonstructural dysfunction of the valve prosthesis occurred 11 times in 10 patients; anticoagulation-related hemorrhage involved 2 patients (1 with nonstructural dysfunction of the valve prosthesis); endocarditis was diagnosed in 3 patients. The consequences of these morbid events concerned 14 patients; reoperations were done 9 times in 8 patients; mortality was valve related in 6 cases. Because 2 more patients died during the course of the study, total late mortality was 8. Probability of survival 5 years after operation was 72% (95% cl 56-83) and at 10 years 47% (95% cl 21-70).(ABSTRACT TRUNCATED AT 250 WORDS)

Surgery in current therapy for infective endocarditis

“…This issue has been extensively addressed and there is substantial evidence that early surgery can be performed safely, but no consensus exists on the optimal timing of valve replacement in the active phase of endocarditis 15,16. Waiting increases the risk of stroke or peripheral emboli while early surgery increases the risk of procedure-related complications, and longer antibiotic treatment can potentially avoid valve replacement.…”

Outcome after mitral valve repair for acute and healed infective endocarditis

“…On the other hand, in the early stages of the disease, the patient's condition is frequently critical and operation in infected tissue is needed. However, preliminary studies have demonstrated good results in patients who were operated in the acute phase [6][7][8][9][10][11][12][13][14][19][20][21].…”