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Related Experiment Videos

Cardiac operations during active endocarditis.

K al Jubair1, M R al Fagih, A Ashmeg

  • 1Riyadh Cardiac Centre, Armed Forces Hospital, Saudi Arabia.

The Journal of Thoracic and Cardiovascular Surgery
|August 1, 1992
PubMed
Summary

Early cardiac surgery for infective endocarditis, particularly with staphylococcal or fungal infections or prosthetic valves, improves outcomes. Prompt operations, within three days of antibiotic therapy, reduce complications and mortality.

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Area of Science:

  • Cardiology
  • Infectious Diseases
  • Cardiac Surgery

Background:

  • Active infective endocarditis (IE) is a serious condition affecting heart valves.
  • IE can be caused by various microorganisms, including staphylococcus, streptococcus, and brucella.
  • Complications include aortic root abscess and embolic phenomena.

Purpose of the Study:

  • To evaluate the outcomes of cardiac operations in patients with active infective endocarditis.
  • To determine the impact of timing of surgery relative to antibiotic therapy on patient outcomes.
  • To identify factors associated with improved prognosis in IE patients undergoing surgery.

Main Methods:

  • Retrospective analysis of 65 patients with active IE who underwent cardiac operations between 1982 and 1990.

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  • Patients were divided into two groups based on surgical timing: within 3 days (Group A) or >3 days (Group B) of antibiotic therapy.
  • Data collected included patient demographics, infecting organisms, valve involvement, complications, and mortality.

    • Main Results:

    • Early surgery (Group A) was associated with fewer preoperative and significantly lower postoperative complication rates compared to delayed surgery (Group B).
    • Preoperative embolic phenomena were more common in Group B patients with large, mobile vegetations.
    • Overall hospital mortality was 13.8%, with staphylococcal or fungal infections in all fatal cases. No reinfections or postoperative paravalvular leaks occurred in Group A.

    Conclusions:

    • Early surgical intervention in active infective endocarditis is recommended, especially for prosthetic valve endocarditis or infections caused by staphylococcus or fungi.
    • Two-dimensional echocardiography identifying moderate to large vegetations is an indication for prompt surgical management.
    • Timely operation, within three days of antibiotic initiation, is crucial for reducing complications and improving patient survival.