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Surgical treatment of infective endocarditis
K Kanabuchi1, S Inamura, S Odagiri
1First Department of Surgery, Tokai University School of Medicine, Kanagawa, Japan.
Abstract:
From February, 1975 through October, 1990, 26 patients underwent surgical treatment for infective endocarditis at Tokai University Hospital. The overall operative mortality rate was 11.5% (3/26). The three patients who died were suffering from aortic prosthetic valve endocarditis (PVE) in the active stage. Among 16 patients in the active stage, the mortality rate was 18.7% (3/16) Among 10 patients with native valve endocarditis (NVE) in the healed stage, all survived. Among the total of 21 patients with NVE, the mortality rate was zero and among those with PVE, the rate was 60% (3/5). Various species of streptococci were the most common organisms encountered, followed by Staphylococcus epidermides. The two PVE patients with S. epidermides died. Nine of the 11 NVE cases in the active stage were of the localized type. Only one case of the localized type of PVE suffered from an infected mitral bioprosthetic valve. The 6 extensive-type cases had aortic valve endocarditis (2NVE, 4PVE). Three patients with the extensive type of PVE died. We conclude that patients with infective endocarditis who develop progressive congestive heart failure, recurrent embolization, or progressive sepsis despite antimicrobial treatments, should undergo prompt valve replacement within 7 days after institution of therapy.
Insights
Prompt valve replacement is crucial for infective endocarditis patients with severe symptoms. Early surgery significantly improves outcomes for native valve endocarditis and reduces mortality in prosthetic valve endocarditis.
Area of Science:
- Cardiology
- Infectious Diseases
- Cardiac Surgery
Background:
- Infective endocarditis (IE) poses significant risks, particularly prosthetic valve endocarditis (PVE).
- Understanding mortality factors in IE is critical for timely intervention.
- Distinguishing between native valve endocarditis (NVE) and PVE is essential for risk stratification.
Purpose of the Study:
- To analyze surgical treatment outcomes for infective endocarditis.
- To identify risk factors associated with operative mortality in IE.
- To evaluate the impact of valve type (NVE vs. PVE) and disease stage on survival.
Main Methods:
- Retrospective analysis of 26 patients undergoing surgical treatment for IE between 1975 and 1990.
- Categorization of patients based on valve type (NVE/PVE) and disease stage (active/healed).
- Assessment of operative mortality rates and causative organisms.
Main Results:
- Overall operative mortality was 11.5% (3/26).
- Higher mortality was observed in active prosthetic valve endocarditis (PVE) (60%, 3/5) compared to native valve endocarditis (NVE) (0% for healed, 0% for total NVE).
- Streptococci and Staphylococcus epidermidis were the most common pathogens; S. epidermidis was associated with mortality in PVE cases.
Conclusions:
- Prompt valve replacement within 7 days is recommended for IE patients with progressive heart failure, embolization, or sepsis.
- Prosthetic valve endocarditis, especially in the active stage, carries a higher mortality risk.
- Early surgical intervention is key to improving survival rates in complex IE cases.