INFECTIVE ENDOCARDITIS - 10-YEAR REVIEW OF MEDICAL AND SURGICAL THERAPY

Background. Infective endocarditis is a complex disease process. Optim al outcome often requires both medical and surgical expertise. The nee d for and timing of surgical intervention is controversial and continu es to evolve in parallel to advancements in diagnosis and treatment. O ur experience with the treatment of infective endocarditis is reviewed herein. Methods. A retrospective review was compiled of 140 consecuti ve patients who fulfilled the modified von Reyn criteria for the diagn osis of endocarditis between January 1982 and April 1992. Results. Pat ient characteristics, symptoms, and risk factors are described. Follow -up averaged 3.5 +/- 0.8 years and totaled 491 patient-years. New York Heart Association functional class at presentation had a significant influence on survival (p < 0.0001). Long-term survival was significant ly greater (p = 0.036) in patients treated medically/surgically than t hose treated with medical therapy alone (75% versus 54% at 5 years). M edical treatment of aortic and prosthetic endocarditis was associated with higher mortality (58% and 67%, respectively) when compared with c ombined medical/surgical treatment (28% and 38%, respectively). Among the survivors, New York Heart Association class at follow-up was bette r (p < 0.0001) in the medical/surgical group (1.05 +/- 0.04) versus th e medical treatment group (1.70 +/- 0.14). Conclusions. Combined medic al/surgical treatment for infective endocarditis is associated with im proved survival. Patients with aortic or prosthetic endocarditis are i dentified as subgroups that benefit most from surgical intervention. V alvular dysfunction incited by the infective process is an important f actor that should be weighed carefully in the therapeutic decision.