Surgical treatment of infective endocarditis

Abstract

Objective — The objective of this study is to determine the surgical indication in the treatment of infective endocarditis.

Setting — Retrospective study in a tertiary care – Wessex Cardiothoracic - Centre.

Subjects and design — Case records of patients admitted with infective endocarditis for surgical treatment between 1984 to 1994 at Wessex Cardiothoracic Centre were analysed. This analysis includes the age, sex, microbiology results, risk factors, surgical indication and early results.

Results — A total of 123 patients was admitted with bacterial endocarditis treated surgically since 1984. The mean age was 51.9 years with male:female ratio of 3:1. The most common causative organism was streptococcus (63%) and staphylococcus (30%). Native valve endocarditis occurred in 111 patients, affecting the aortic, mitral, combined aortic and mitral valve in 69%, 33%, and 8% of cases, respectively. Late prosthetic valve endocarditis occurred in 12 patients. The most common indication for surgery was heart failure (84%), uncontrolled sepsis (8%), and recurrent endocarditis (2.5%). Hospital mortality was 1.6%. Complete heart block and cerebrovascular accident developed in 4% and 2.4%, respectively.

Conclusions — Heart failure is the main indication for surgery.Valve replacement with mechanical prosthesis is a safe procedure with a low rate of mortality and complication.

Key Words:

• infective endocarditis
• valve replacement
• heart failure
• streptococcus infection