ACTIVE INFECTIVE ENDOCARDITIS - SURGICAL APPROACH

From January 1982 to December 1991, 65 interventions were performed in 61 patients with active infective endocarditis (IE): 32 on native val ves (Group 1) and 33 on prosthetic valves (Group 2). In Group 1, 23 pa tients had a known previous valve disease; major preoperative clinical complications occurred in 16 patients (50%); 84% were in NYHA classes III and IV. In Group 2 major preoperative clinical complications occu rred in 13 patients (44.8%); 86% were in NYHA classes III and IV. The mean time interval between the onset of hemodynamic impairment of vary ing degrees and surgery was 13 +/- 15 days for Group 1, and 8 +/- 11 d ays for Group 2. In all cases, the native valves or prostheses were re placed by mechanical valve prostheses. Particular procedures were perf ormed in three patients in Group 1 and five patients in Group 2. In Gr oup 1 there were 8 hospital deaths (25%) and 11 (34.4%) non-fatal comp lications. In Group 2 there were 9 deaths (31%) and 14 (48.3%) non-fat al complications. Risk factors for hospital death were ''preoperative low cardiac output syndrome'' and ''time interval between the onset of cardiac failure and surgery'' in Group 1, ''cardiac failure + sepsis' ' in Group 2, ''time interval between the onset of cardiac failure and surgery'' and ''particular procedures'' in all 61 patients. Sepsis al one and the type of pathogenic agent does not significantly affect the risk of death. The recurrence of acute IE was 12.6% in Group 1, and 2 0% in Group 2. The incidence of reintervention was 12.6% in Group 1 an d 35% in Group 2. Staphylococcal infections led to a greater incidence of local complications and, in patients operated on for prosthetic IE , proved to be a risk factor for late recurrence. The prognosis of pat ients with IE is mainly affected by the severity of clinical status at the moment of the surgical indication. Failure to control the infecti on medically, even after only 1-2 weeks of treatment, the occurrence o f embolic complications with echocardiographic demonstration of valvul ar or prosthetic vegetations or hemodynamic impairment, particularly i n the presence of failure to control the infection, require early surg ical treatment.