[Surgical treatment of active infective endocarditis: analysis of 20 years' experience]

Changes in perioperative condition and outcomes of surgically treated patients with active infective endocarditis were evaluated during the last 20 years.

Between 1983 and 2002, 132 patients with active infective endocarditis underwent surgery at Saitama Medical School. Changes in frequency, pathogens, clinical features, surgical results, and perioperative treatment were compared between four periods of 5 years.

The percentage of surgery for infective endocarditis remained almost the same among all cardiovascular procedures. Staphylococcal infective endocarditis increased significantly (p < 0.01), and prosthetic valve infective endocarditis and periannular abscess became more common. Surgery tended to be performed in severely ill patients significantly more frequently (p < 0.01). If all patients were included, hospital mortality did not decrease significantly, at 1.7% in stable patients, but 50% in critically ill patients. Intensive care unit stay became relatively longer. Recurrent infection was observed significantly more frequently in critically ill patients and in patients with prosthetic valve infective endocarditis. Patients were referred for surgery following diagnosis and underwent surgery at increasingly more appropriate timing. However, the diagnosis of infective endocarditis took 1.5 months to establish regardless of the patient's condition or the clinical outcome. Moreover, antibiotics were administered orally in around 90% and intravenously in nearly 70% of the patients without microbiological tests, and negative cultures remained very frequent.

Critically ill patients underwent surgery increasingly more frequently, and surgical outcomes remained unsatisfactory over the last 20 years. Early diagnosis and avoidance of premature antibiotic therapy may be important for future improvement.