[Surgical treatment of high-risk valvar endocarditis]

The authors have studied the immediate and long term outcome of surgical treatment of acute phase infective endocarditis in a group of 33 high risk patients with valvular heart disease. The age varied from 2 to 68 years, 18 patients were male and 22 were of the white race. The aortic valve was the most frequently involved (18/54.5%), followed by mitral valve (13/39.3%), and tricuspid valve (2/6.0%). Twenty-four patients (72.7%) were in functional class III and seven (21.0%) in functional class IV. The noninvasive studies in those patients revealed 13 cases (39.4%) with normal cardiac size. The EKG was abnormal in 27 cases (81.8%) mostly with left atrial and ventricular hypertrophy. The echocardiogram revealed the presence of vegetations in 27 patients (81.8%) and the blood cultures were positive in 24 cases (72.7%). All patients were treated with antibiotics. The pathologic analysis revealed the presence of vegetations in 94% and structural alterations in 16.5%. Twenty-one patients had heart valve replacement with mechanical prosthesis (63.6%), 11 (33.3%) had bioprosthesis and one had tricuspid excision without replacement (3.0%). The hospital mortality was 12% and the late mortality 3%. Three deaths occurred in patients who had prolonged clinical treatment (more than 35 days) and one patient died of severe fungal endocarditis. The follow-up of the remaining 26 patients varied from 1 to 596 weeks (mean 183) demonstrating important clinical improvement and a normally functioning valve prosthesis. All patients remained in functional class I or II. The analysis of our data indicates that surgical treatment is the best option for high risk endocarditis and should be undertaken earlier in all patients in this group.