[Efficacy of Early Surgical Strategy for Active Infective Endocarditis]

The aim of study was to analyze the outcome of aggressive, early surgical intervention to active infective endocarditis (IE) complicated by acute congestive heart failure, uncontrollable infection and large, mobile vegetation and to evaluate the validity of current therapeutic strategy on it's long-term outcome.

We retrospectively investigated surgical outcome of 51 patients who underwent surgical intervention to eradicate intra-cardiac infection and to reconstruct subsequent structural destruction due to active IE performed between 2002 and 2013. Patient's mean age was 56 ± 17 (14~83) years and 36 males, 2 prior cardiac surgery-performed and 2 hemodialysis-dependent renal failure patients were included. All patients were followed on long-term basis. Mean follow up duration was 61 ± 46 (1~164) months. We classified patients into 2 groups according to urgency of surgical intervention:early surgical (ES) group who underwent surgery within 2 weeks from diagnosis of IE and conservative surgical (CS) group who underwent after 2 weeks more from the diagnosis.

Two patients died during hospitalization due to low cardiac output syndrome (LOS) for ischemic myopathy after old myocardial infarction and postoperative ischemic colitis (preoperative hemodialysis-dependent patient). Two cerebral infarctions and 1 hemorrhagic transformation of cerebral infarction occurred postoperatively. There was no mediastinal infection and recurrent intracardiac infection postoperatively. On long-term follow up, cumulative survival was 90/79/68% in 1/5/10 years. on ES group and 100/89/79% in 1/5/10 years. on CS group, respectively. Freedom from cardiac death were 100/100/100% in 1/5/10 years. on ES group and 100/100/100% in 1/5/10 years. on CS group, respectively. There were 1 cardiac death(125 months after operation) and 8 non-cardiac deaths on long-term survival.

Early surgical strategy for active infective endocarditis to prevent IE-related preoperative adverse complications seems to be acceptable.