EARLY SURGERY IN THE ACUTE-PHASE OF INFEC TIVE ENDOCARDITIS COMPLICATED BY HEART-FAILURE - THE MAROCCAN EXPERIENCE

The aim of this review of 20 cases was to identify the surgical indica tions in heart failure complicating the acute phase of native left hea rt valve endocarditis, to determine the optimal timing of surgery and to evaluate the early and medium term postoperative prognosis. Between January 1985 and May 1990, 20 patients (14 men and 6 women with an av erage age of 29 +/- 7 years) with native left heart valve endocarditis underwent surgery in the acute phase complicated by heart failure. Th e were 9 aortic regurgitations, 5 mitral regurgitations, 4 mixed mitra l and aortic regurgitations and 2 mixed mitral and tricuspid regurgita tions. The haemodynamic status of the patients was poor before surgery : 15 NYHA class IV and S class III. The average time from the onset o f heart failure to surgery was 21 days. The surgical procedure was mon ovalvular replacement in 14 cases, double valve replacement in 4 cases and 2 isolated mitral valvuloplasties. Two patients died in the first postoperative month of irreducible low output syndrome. One patient w as reoperated early for dehiscence of a mechanical valve prosthesis. L ate complications included 2 cerebrovascular accidents and one reopera tion for degeneration of a bioprosthesis. There were nolate fatalities . Seventeen of the 18 survivors are regularly followed up with an aver age of 80 months follow-up : 12 NYHA class I and 5 class II. The most useful prognostic factor was the preoperative haemodynamic status. The results of this study underline the value of early surgery before the appearance of the first signs of haemodynamic intolerance. When perfo rmed at this stage, surgery may radically transform the prognosis with low mortality and morbidity and stable long-term results.