The results of surgery for active endocarditis of the native aortic valve

Between 1968 and 1981, 40 patients with active endocarditis of the native aortic valve were treated by aortic valve replacement (A.V.R.). There were 8 postoperative deaths (hospital mortality 20%). This included 5 patients who had developed cardiogenic shock prior to surgery. Antibiotic treatment for less than one week and positive cultures on the excised valve had poor prognostic implications but tended to be associated with irreversible haemodynamic failure. Twenty five patients underwent A.V.R. following the onset of severe pulmonary oedema. The hospital mortality in this group was 28% and the 5 year actuarial survival 56% (+/- 11%). Fifteen patients who had developed premature closure of the mitral valve (P.C.M.V.) on M-mode echocardiography but who had no overt signs of cardiac failure underwent A.V.R. with a single death (7% hospital mortality). The 5 year actuarial survival in this group was 87% (+/- 9%). P.C.M.V. is a useful prognostic sign identifying those patients with endocarditis on the native aortic valve likely to benefit from early surgery.