Active infective endocarditis: low mortality associated with early surgical treatment

Background: Early surgical treatment is important for successful outcome in selected cases of active, either native (NVE) or prosthetic valve endocard itis (PVE). The aim of this study was to evaluate the early results of the surgical treatment of active NVE and PVE. Methods: During a 3-yr period (January 1 1996-December 31 1998), 57 out of 60 patients (pts) with active, either NVE (46 pts) or PVE (11 pts) underwen t surgical treatment. There were 11 women (23.9%), average age of the group being 43.3 +/- 9.1 yr (18-73). They were operated on 12-35 days, mean 17.7 +/- 7.5 days (for NVE) and 5-33 days, mean 13.2 +/- 10.1 days (for PVE) af ter the diagnosis of endocarditis was first suspected. All pts had at least one absolute indication for early surgical treatment, the most frequent be ing (in NVE) worsening heart failure (19 cases) and inability to control th e infection (10 cases). while in PVE it was valve dehiscence (8 cases). In 8 cases of NVE and 2 cases of PVE fresh, antibiotic sterilized aortic homog raft was used to replace the aortic valve. Results: Operative mortality was 1.8% (1/57) and hospital mortality 5.2% (3 /57). Three pts with PVE died before they were operated on, giving an overa ll mortality of 10% (6/60). Post-operative morbidity included valve dehisce nce in two pts (probable late onset recurrent endocarditis - 3.5%), three e pisodes of acute renal failure (5.3%), four cases of respiratory insufficie ncy (7.0%) and one chronic pleural effusion (1.8%). All pts that were disch arged from the hospital (54/60), are still alive and well 1-35 months posto peratively (mean 20.3 +/- 9.6 months), including pts with recurrent endocar ditis and valve dehiscence, after they were successfully reoperated. Conclusions: Along with early diagnosis and appropriate antibiotic treatmen t, aggressive surgical attitude is of importance for the successful outcome in this group of seriously ill patients. Our data indicate that early surg ical treatment in cases of active endocarditis may be associated with low m ortality and morbidity. (C) 2000 The International Society For Cardiovascul ar Surgery. Published by Elsevier Science Ltd. All rights reserved.