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The surgical management of bacterial endocarditis: a review
Abstract:
A total of 239 surgically treated patients with primary endocarditis were reviewed both from the literature and from our own experience. The age range was 10 to 74 years with a male to female ratio of 3:1. A wide variety of organisms was found. However, as a group, gram positive organisms predominate. The onset of congestive failure was the major indication for surgery. The aortic valve was predominantly involved with the mitral valve running a distant second. The hospital mortality rate was 20% and the late mortality rate was 6.7% with an overall mortality of 26.7%. The prognosis in infective endocarditis when congestive failure develops, even in the presence of antibiotic therapy, is poor (79-89% mortality). In view of this poor prognosis, an aggressive attitude with regard to early surgical intervention can greatly improve the outcome of valvular endocarditis.
Insights
Early surgery significantly improves outcomes for patients with infective endocarditis, particularly when congestive heart failure develops. Aggressive surgical intervention is crucial for better prognosis in valvular endocarditis.
Area of Science:
- Cardiology
- Infectious Diseases
- Cardiac Surgery
Background:
- Infective endocarditis is a serious infection affecting heart valves.
- Congestive heart failure is a common complication, indicating a poor prognosis.
Purpose of the Study:
- To evaluate the outcomes of surgically treated patients with primary endocarditis.
- To determine the impact of early surgical intervention on prognosis.
Main Methods:
- Review of 239 surgically treated patients with primary endocarditis from literature and personal experience.
- Analysis of patient demographics, causative organisms, surgical indications, mortality rates, and valve involvement.
Main Results:
- Gram-positive organisms were the predominant pathogens.
- Aortic valve involvement was most common, followed by the mitral valve.
- Hospital mortality was 20%, with an overall mortality of 26.7%.
Conclusions:
- Congestive heart failure in endocarditis carries a high mortality rate (79-89%), even with antibiotics.
- Early and aggressive surgical intervention is recommended to improve outcomes in valvular endocarditis.