Factors affecting the surgical management of infective endocarditis

Congestive heart failure and septic embolism complicate the clinical course of patients with infective endocarditis (IE). This study reviews the clini cal records of patients with systemic disease secondary to IE and stratifie s their disease severity according to individual risk factors and medical, and surgical interventions. The hospital records of all patients presenting to our institution from 1992 through 1997 with heart valve destruction sec ondary to IE were reviewed. Ten patients with hemodynamically significant v alve lesions were included in this study: seven with aortic valve disease a nd two with mitral valve disease, and one with combined aortic and mitral v alve lesions. All were diagnosed by echocardiogram. All ten patients experi enced systemic septic arterial emboli: four intracranial lesions, four visc eral lesions, and three extremity arterial occlusive events. Two patients r equired peripheral arterial repair. Cultures revealed infection secondary t o Staphylococcus aureus in five, Streptococcus species in three, Coxiella s pecies in one, and an unidentified organism in one patient. Seven patients underwent valve replacement. Three patients died from their disease process es. Statistical significance was established by Wilcoxon rank analysis with a two-tailed P < 0.05. Patients with IE secondary to staphylococcal infect ions suffered a more acute and virulent disease process (P = 0.04), with a 40 per cent mortality rate in the first 48 hours. There was no increased in cidence of embolization associated with longer duration of symptoms (P = 0. 32). Surgical repair conferred improved clinical outcome as compared with n o surgical intervention (P = 0.03). Improved patient outcome was associated with nonstaphylococcal infection (P = 0.02), and a successful initial anti biotic regimen (P = 0.03). Peripheral arterial repair was successful in bot h cases.