4Acute endocarditis treated with radical debridement and implantation of mechanical or stented bioprosthetic devices

Background. Operation for active infective endocarditis carries high mortal ity and morbidity rates, especially when the annulus is involved. Overall t he literature favors the use of autograft and homograft valves because of b etter resistance to infection. In our clinic during the last 5 years we use d an aggressive surgical approach to infective endocarditis in combination with implantation of mechanical or stented bioprosthetic devices. Methods. From 1994 to 1999, 50 adults with aortic and/or mitral valve endoc arditis underwent valve replacement. The median age of the 36 men and 14 wo men was 58 years (range, 17 to 78 years). All patients had active endocardi tis at the time of operation. Native valve endocarditis was present in 48 p atients and prosthetic valve endocarditis was present in 2 patients. The ao rtic valve was affected in 24 patients, the mitral valve in 21 patients, an d both the aortic and mitral valves in 5 patients. Two of the patients with mitral endocarditis also had infection of the tricuspid valve. Annular des truction was present in 24 patients (48%). The patients were treated with r adical excision of all infected tissue. The annular defects were closed, if possible, with direct sutures. Otherwise, a reconstruction was performed. Follow-up was 100% complete with a median follow-up period of 45 months (ra nge, 6 to 66 months). Results. The procedures were performed without lethal bleeding complication s. Early mortality was 12% and the actuarial survival at follow-up was 80%. In none of the patients who died was death related to the prosthetic valve or recurrence of the endocarditis. Only 1 patient (2%) developed recurrenc e of the infective endocarditis and was reoperated with a Ross procedure. T hree and a half years later the patient developed severe valve insufficienc y of the autograft and was operated again with implantation of a mechanical device. Conclusions. Native and prosthetic valve endocarditis can be treated succes sfully with aggressive surgical debridement and implantation of mechanical or stented bioprosthetic devices with a low risk of recurrent endocarditis. (Ann Thorac Surg 2001;71:100-4) (C) 2001 by The Society of Thoracic Surgeo ns.