Related Experiment Videos
Infective endocarditis: a lethal disease
Insights
Early surgical intervention for infective endocarditis (IE) improves survival, especially in patients with severe heart failure or persistent fever after one week of antibiotics. Prompt surgery is crucial for better outcomes in IE cases.
Area of Science:
- Cardiology
- Infectious Diseases
- Cardiac Surgery
Background:
- Infective endocarditis (IE) is a serious infection affecting heart valves.
- Outcomes in IE are influenced by various factors including patient condition and treatment approach.
Purpose of the Study:
- To analyze factors affecting outcomes in infective endocarditis.
- To evaluate the impact of surgical intervention timing on patient survival and recurrence rates.
Main Methods:
- Retrospective analysis of 189 IE episodes in 177 patients over 18 years.
- Correlation of clinical features, cardiac lesions, infecting organisms, and surgical intervention with patient outcomes.
Main Results:
- Overall hospital survival was 79%, with a 13-year actuarial survival of 47%.
- Patients with severe heart failure had higher survival (69%) with early surgery versus antibiotic completion (40%).
- Persistent fever after one week of antibiotics indicated higher complication rates (61% infected pannus) and lower survival (53%) compared to afebrile patients (96% survival).
Conclusions:
- Early surgical intervention is associated with improved survival in infective endocarditis, particularly in severe cases.
- A treatment policy advocating for surgery when infection and heart failure signs persist beyond one week of antibiotic therapy may yield better results.
Abstract:
One-hundred-and-eighty-nine episodes of infective Endocarditis were seen in 177 patients in the Green Lane Cardiology Unit over a 18-year period. Hospital survival was 79% and 13-year actuarial survival was 47%. A number of factors including the underlying cardiac lesion, infecting organism, clinical features and surgical intervention were related to outcome. No patient with extreme heart failure survived without operation. Hospital survival in patients with severe heart failure was 69% (9/13 patients) where surgery was carried out before completion of antibiotic treatment, and 40% (6/15 patients) where the antibiotic course was completed. Survival was 53% in patients who still had a fever after one week of antibiotic treatment and 96% if the temperature was normal. In 61% of patients with a fever at one week, extended infected pannus was present compared with 6--10% where the temperature was normal. In patients undergoing operation before completion of antibiotics, the surgical mortality was higher but neither the incidence of recurrence of endocarditis nor the need for re-operation was increased. We believe that better results will be achieved with a policy of surgical intervention when signs of infection and heart failure have not settled within one week of treatment.