Original Articles
Operation for Infective Endocarditis: Results After Implantation of Mechanical Valves

Presented at the “Meet the Expert Session” of the Thirty-third Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Feb 3–5, 1997.
https://doi.org/10.1016/S0003-4975(97)01092-8Get rights and content

Abstract

Background. Operation for acute endocarditis during the active phase violates a basic surgical rule not to implant a foreign body into an infective process, resulting in a high operative mortality and the risk of early recurrent endocarditis. Several investigators analyzing risk factors for perioperative mortality and morbidity presented strategies for more favorable outcomes, but most studies suffer from the drawback of heterogeneous populations observed over a long period of time.

Methods. We present a prospective study on 138 patients operated on from March 1988 to March 1996. Patients were only included if the activity of the infection was proved by positive culture of the valve leaflets or by histologic staining. During the observation period, indication for operation, surgical approach, and postoperative antibiotic therapy were standardized as much as possible. After radical debridement of all parts of infected tissue, valve replacement was carried out with mechanical prostheses.

Results. The early mortality was 11.5% overall. High New York Heart Association functional classification, advanced age, and staphylococcal disease were significant risk factors for early mortality. The site of infection, multiple valve involvement, and prosthetic valve endocarditis did not affect the outcome. Early recurrent endocarditis was recorded in only 3 patients of the entire series.

Conclusions. In case of acute infective endocarditis, valve replacement with mechanical prostheses is a safe procedure, if radical operation and aggressive postoperative antibiotic therapy are performed. For further improvements of the results, earlier operation is advisable in patients with rapidly progressive cardiac deterioration and in most cases of staphylococcal endocarditis.

Section snippets

Patients

In an 8-year period between March 1988 and March 1996, 138 patients underwent operation for acute infective endocarditis. There were 29 women and 109 men (mean age, 50.5 years; range, 20 to 78 years). One hundred twenty-three patients had endocarditis of the native valve, whereas in 15 patients prosthetic valve endocarditis was present (Table 1). Patients were only included in the study if the endocarditis had to be considered “definite” according to the criteria proposed by von Reyn [7], that

Mortality

The early mortality (within 30 days after the operation) in this series was 11.5% (16 patients). The main reasons for death were cardiac failure (11 patients) and septic multiorgan failure (3 patients); sepsis in these patients was not associated with recurrent or persistent infection of the valve prosthesis. Two patients died in tabula from uncontrollable bleeding. Both had a long-standing history of endocarditis leading to severe pancarditis and infectious alteration of atrial and ventricular

Comment

Surgical treatment of an acute infective endocarditis by valve replacement still remains a challenge to the surgeon, because it does not only require hemodynamic repair, but also special emphasis on the eradication of the infectious focus to prevent early postoperative colonization of the prosthesis by remaining microorganisms. This goal can be achieved by the combination of aggressive surgical therapy and adequate postoperative intensive care.

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