Urgent valve heart replacement in infectious endocarditis: short and long-term prognosis. Analysis of 45 patients

BACKGROUND: To define the evolution of patients with infective endocarditis who require urgent valve replacement in our environment. PATIENTS AND METHODS: We followed 45 consecutive cases of infective endocar ditis that require valve replacement during their hospitalization. 32 patie nts had native valve infective endocarditis, 7 early prosthesis valve endoc arditis and 6 late prosthesis valve endocarditis. Patients were followed fo r a long-term period, clinical and echocardiographycally. RESULTS: In 39 cases valve replacement was performed before ending antibiot ic therapy. The main indications for surgery were refractory heart failure (24 patients) and shock (11 patients). The mortality rate was 24%: 19% in n ative valve infective endocarditis, 43% in early prosthetic valve endocardi tis and 33% in late prosthesis valve endocarditis. The first cause of death was septic shock (46%). We followed 31 over 34 survivors for a mean time 6 5 (DS 49) months. We found two relapses and six deaths (1 sudden death, 2 e ndocarditis) and 72% of patients presented class I NYHA. We detected 17% pr osthetic leaks (34% in the prosthetic valve endocarditis group). CONCLUSIONS: The need of urgent valve replacement in the context of infecti ve endocarditis is associated with a high mortality rate, and should be con sidered a serious condition. Long term prognosis is, however, acceptable, a lthough 17% of patients had prosthesis leak, specially those with prostheti c valve endocarditis.