THE RISK OF INFECTIVE ENDOCARDITIS AFTER INTRACARDIAC SURGERY

The risk of infective endocarditis (IE) after intracardiac surgery is dominated by the risk of IE on valvular prostheses. The reported preva lence of IE on prosthetic valves varies according to the chosen diagno stic criteria of IE and its timing. The risk of early IE is 0,4 to 1,3 % and the linearised annual risk of late IE is about 0,5 %. These val ues appear to be identical irrespective of the type and site of the pr osthesis : the risk is higher in multiple valve replacement. In early IE, the commonest infecting organism is the staphylococcus : the bacte riological spectrum of late IE is the same as that of IE on native val ves. The portal of entry is often detected in early IE but more rarely (50 %) in late IE. The risk of IE in operated congenital heart diseas e is very low after surgery of left-to-right shunts or valvular stenos is ; it is higher for patients with Tetralogy of Fallot and those with complex cyanotic disease, especially in cases with residual ventricul ar septal defects and with palliative surgery such as systemico-pulmon ary anastomosis. The risk of IE on endocavitary catheters (pace-maker, defibrillator) after interventional cardiac procedures and after card iac transplantation, seems to be very low. These results show that pre ventive measures against IE are only routinely required in prosthetic valve patients and after surgery of Tetralogy of Fallot and complex cy anotic cardiac disease.