EARLY SURGERY IN INFECTIVE ENDOCARDITIS

Optimal timing of surgical intervention in infective endocarditis is i mportant in reducing mortality. We prospectively studied 126 consecuti ve episodes of infective endocarditis treated in one institution over 5 years, with special emphasis on long-term results and on the effects on outcome of surgical interventions. Twenty-six patients (21%) under went acute surgery on median treatment day 14. Mortality during treatm ent was 8% for patients undergoing acute surgery vs. 11% for those not undergoing surgery, and the adjusted 5-year survival rate of acute su rgically treated patients was 91%, compared with 69% for the medically treated patients. Using univariate analysis, excess mortality during 5 years follow-up was associated with new cardiac decompensation at en try (p<0.01), age (p<0.01), no acute surgery (p<0.05) and mitral valve involvement (p<0.05). Multivariate analysis showed new cardiac decomp ensation at entry to be an independent predictor of cardiac death at 5 years follow-up (relative risk 2.39; Cl 1.05-5.45), while no surgery during active disease implied a relative risk of 3.45, though not stat istically significant. Patients undergoing surgery very early (less th an or equal to 10 days of treatment) did not have a poorer outcome. Ac ute valve replacement, as compared with medical therapy only, might be important to increase both short-term and long-term survival in infec tive endocarditis.