Related Experiment Video

Updated: Jul 18, 2026

An In Vitro Model of a Parallel-Plate Perfusion System to Study Bacterial Adherence to Graft Tissues
07:50

An In Vitro Model of a Parallel-Plate Perfusion System to Study Bacterial Adherence to Graft Tissues

Published on: January 7, 2019

Surgical treatment of active infective endocarditis: a continued challenge

Tirone E David1, Gheorghe Gavra, Christopher M Feindel

  • 1Division of Cardiovascular Surgery of Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada. tirone.david@uhn.on.ca

The Journal of Thoracic and Cardiovascular Surgery
|January 3, 2007
PubMed

Insights

Surgery for active infective endocarditis remains challenging, with high mortality rates. Key predictors of poor outcomes include preoperative shock, prosthetic valve endocarditis, and Staphylococcus aureus infections.

Area of Science:

  • Cardiovascular Surgery
  • Infectious Diseases
  • Cardiac Valve Surgery

Background:

  • Active infective endocarditis (IE) is a serious condition requiring surgical intervention.
  • Outcomes of surgical treatment for IE can vary significantly based on patient and disease factors.

Purpose of the Study:

  • To evaluate the surgical outcomes in a large cohort of patients with active infective endocarditis.
  • To identify predictors of mortality and long-term survival after IE surgery.

Main Methods:

  • A retrospective analysis of 383 consecutive patients undergoing surgery for active IE.
  • Data collected included patient demographics, valve status (native vs. prosthetic), causative microorganisms, surgical procedures, and follow-up duration.
  • Statistical analysis identified independent predictors of operative mortality and overall survival.

Main Results:

  • Operative mortality was 12%, with no significant change over time.
  • Late deaths occurred in 23% of patients.
  • Independent predictors of operative mortality included preoperative shock, prosthetic valve endocarditis, paravalvular abscess, and Staphylococcus aureus.
  • Fifteen-year survival was 44% overall, with lower survival for prosthetic valve endocarditis (25%) compared to native valve endocarditis (59%).

Conclusions:

  • Surgery for active infective endocarditis is associated with substantial operative mortality and morbidity.
  • Factors such as age, shock, prosthetic valve endocarditis, impaired ventricular function, and recurrent infections negatively impact long-term survival.
  • Despite challenges, surgical intervention remains critical for managing active IE.
Abstract

Related Concept Videos

Endocarditis III: Medical Management01:18

Endocarditis III: Medical Management

Infective endocarditis management involves a multifaceted approach encompassing infection prevention, lifestyle modifications, pharmacological therapy, and surgical management.Infection Prevention:Hand Hygiene: Thorough handwashing is crucial to prevent the spread of infection. Hand hygiene should be performed regularly, especially before and after using the restroom.Oral Hygiene: Good oral hygiene is essential. It includes brushing teeth immediately after waking up and before bed, flossing...
Endocarditis IV: Nursing Management01:29

Endocarditis IV: Nursing Management

Infective endocarditis (IE) is a chronic infection of the heart's endocardium, primarily affecting the heart valves. A detailed nursing assessment for a patient with IE involves collecting subjective and objective data to ensure an accurate diagnosis and timely intervention.Subjective DataThe nurse gathers information about the patient's symptoms and complaints during the subjective assessment. Patients with infective endocarditis often report non-specific symptoms that can mimic other...
Endocarditis I: Introduction01:25

Endocarditis I: Introduction

Introduction:Endocarditis is the infection of the endocardium, the inner lining of the heart and its valves. When the heart muscle is involved, the condition is termed myocarditis, while an infection of the outer lining is called pericarditis. Infective endocarditis (IE) primarily affects the endocardium, where pathogens adhere to the valves or lining, forming vegetation that can lead to severe complications. Infective endocarditis occurs when microorganisms, usually bacteria from other body...
Endocarditis II: Clinical Features of Infective Endocarditis01:25

Endocarditis II: Clinical Features of Infective Endocarditis

Endocarditis can present various clinical features depending on the causative organism and the patient's underlying health conditions. Initially, the clinical features of infective endocarditis develop gradually, presenting with nonspecific symptoms that can be easily mistaken for other illnesses.General SymptomsEarly symptoms of infective endocarditis are fever, chills, weakness, malaise, fatigue, and weight loss. These symptoms reflect the systemic nature of the infection and the body's...
Pericarditis III: Medical Management01:17

Pericarditis III: Medical Management

The primary objectives of managing pericarditis are to determine the underlying cause, provide effective therapy for treatment and symptom relief, and promptly detect signs and symptoms of cardiac tamponade. The following outlines the essential aspects of medical management for pericarditis:ObjectivesDetermine the Cause: Identifying the underlying cause of pericarditis is crucial for targeted treatment. Causes include viral infections, autoimmune diseases, post-cardiac injury syndrome, and...
Myocarditis III: Medical Management01:14

Myocarditis III: Medical Management

Myocarditis: Comprehensive Medical ManagementMyocarditis, the heart muscle inflammation, requires a comprehensive medical management strategy that addresses the underlying cause, provides supportive care, manages symptoms, and reduces cardiac workload.Infections and Autoimmune CausesAdminister appropriate antimicrobial therapy when an infectious agent causes myocarditis. For instance, penicillin treats infections caused by Group A Streptococcus. In cases where autoimmune processes are...