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Valve replacement in acute native valve endocarditis.

R Soyer, M Redonnet, J P Bessou

    The Thoracic and Cardiovascular Surgeon
    |June 1, 1986
    PubMed
    Summary
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    Emergency valve replacement for acute native valve endocarditis offers significant clinical improvement. Early surgery benefits survivors, with postoperative antibiotics crucial for preventing reinfection.

    Area of Science:

    • Cardiology
    • Infectious Diseases
    • Cardiac Surgery

    Background:

    • Native valve endocarditis (NVE) is a serious infection requiring prompt intervention.
    • Hemodynamic instability, sepsis, and embolic events are common complications of NVE.

    Purpose of the Study:

    • To evaluate the outcomes of emergency valve replacement surgery in patients with acute NVE.
    • To identify factors influencing operative mortality and long-term survival.

    Main Methods:

    • Retrospective analysis of 46 patients undergoing emergency surgery for NVE between 1974 and 1984.
    • Assessment of indications for surgery, patient functional class, causative organisms, and valve involvement.
    • Evaluation of operative mortality, late mortality, and long-term survival rates.

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    Main Results:

    • Urgent valve replacement was indicated for hemodynamic deterioration (73%), sepsis with heart failure (19%), and emboli (7%).
    • Aortic regurgitation was the most frequent valve lesion (34 cases).
    • Operative mortality was 17%, primarily due to preoperative multi-system deterioration, particularly in cases with combined mitral and aortic valve lesions. Actuarial survival was 67% at a mean follow-up of 44 months.

    Conclusions:

    • Emergency valve replacement is beneficial for patients with acute NVE, leading to excellent clinical improvement in survivors.
    • Early surgical intervention is critical for favorable outcomes.
    • Postoperative antibiotic therapy, particularly for 6 weeks, appears important for preventing reinfection.