Surgical management of native valve endocarditis

Area of Science:

• Cardiology
• Infectious Diseases
• Cardiac Surgery

Background:

• Bacterial endocarditis frequently necessitates urgent valve replacement.
• Patients often present with advanced heart failure (NYHA Class III/IV).
• Pre-existing valvular lesions are not always present.

Purpose of the Study:

• To evaluate outcomes of urgent valve replacement for left-sided bacterial endocarditis.
• To identify risk factors and optimal timing for surgical intervention.
• To assess the impact of antibiotic regimens on reinfection rates.

Main Methods:

• Retrospective analysis of 40 patients undergoing urgent valve replacement for bacterial endocarditis (1972-1981).
• Assessment of New York Heart Association (NYHA) functional class and pre-existing valvular conditions.
• Echocardiography used for diagnosis and surgical timing.
• Analysis of operative mortality, risk factors, and long-term outcomes including reinfection.

Main Results:

• Eight operative deaths (20%) occurred.
• Prompt surgery (within 4 days) for NYHA Class IV patients significantly improved survival (19/19 survived).
• Delayed surgery in Class IV patients resulted in 100% mortality.
• Postoperative antibiotic duration (4-6 weeks) was associated with low reinfection rates (1/16).

Conclusions:

• Urgent valve replacement is effective for bacterial endocarditis, particularly when performed rapidly in critically ill patients.
• Timely surgical intervention is crucial for improving survival in severe heart failure.
• Prolonged postoperative antibiotic therapy is vital for preventing recurrent infections.