Valvular Surgery During Infective Endocarditis

Abstract

Between 1984 and 1991, 76 patients with mean age 36.3 ± 15.4 years were operated on at the authors' institute for active infective endocarditis (IE). In 47.3%, blood cultures were negative. Indications for surgery were progressive heart failure, uncontrolled infections, and embolisms. The surgical mortality rate was 23.7%, which is higher than that in patients without IE operated on during the same interval in this center (P < 0.0001). Actuarial survival was 80.8 ±5.9% over nine years of follow-up. Fifty-six patients had native valve endocarditis with a surgical mortality of 14.2%, which is higher than that in patients without IE in the authors' experience (P < 0.05). Actuarial survival in patients operated on for native valve IE was 87.3 ±5.4% over nine years. The aortic valve involvement increased the surgical mortality. Twenty patients had pros thetic valve endocarditis (5 early and 15 late) with an overall surgical mortality of 50% and actuarial survival of 52.5 ± 17.5% over nine years. The surgical deaths were caused by sepsis (61.1%), heart failure (22.2%), bleeding (11.1%), and acute renal failure (5.5%). In the 76 patients, the actuarial curve showed 79.7 ± 6.3% event-free patients (continued on next page) over nine years. The events analyzed were reoperation, recurrence of IE, thromboem bolism, and perivalvular leak. The group operated on with native valve IE had 79.5 ±6.7% event-free patients over nine years. Bioprostheses were employed in 75.7% of the patients with native valve IE and in all patients with prosthetic valve IE. The authors' experience shows the following: (1) Active IE increases significantly the surgical mortality in valvular heart disease. (2) Aortic valve involvement worsens the prognosis. (3) Because of the good long-term survival and the low rate of complication, bioprostheses may be safely employed.