OPERATION FOR INFECTIVE ENDOCARDITIS - RESULTS AFTER IMPLANTATION OF MECHANICAL VALVES

Background. Operation for acute endocarditis during the active phase v iolates a basic surgical rule not to implant a foreign body into an in fective process, resulting in a high operative mortality and the risk of early recurrent endocarditis. Several investigators analyzing risk factors for perioperative mortality and morbidity presented strategies for more favorable outcomes, but most studies suffer from the drawbac k of heterogeneous populations observed over a long period of time. Me thods. We present a prospective study on 138 patients operated on from March 1988 to March 1996. Patients were only included if the activity of the infection was proved by positive culture of the valve leaflets or by histologic staining. During the observation period, indication for operation, surgical approach, and postoperative antibiotic therapy were standardized as much as possible. After radical debridement of a ll parts of infected tissue, valve replacement was carded out with mec hanical prostheses. Results. The early mortality was 11.5% overall. Hi gh New York Heart Association functional classification, advanced age, and staphylococcal disease were significant risk factors for early mo rtality. The site of infection, multiple valve involvement, and prosth etic valve endocarditis did not affect the outcome. Early recurrent en docarditis was recorded in only 3 patients of the entire series. Concl usions. In case of acute infective endocarditis, valve replacement wit h mechanical prostheses is a safe procedure, if radical operation and aggressive postoperative antibiotic therapy are performed. For further improvements of the results, earlier operation is advisable in patien ts with rapidly progressive cardiac deterioration and in most cases of staphylococcal endocarditis.