[Risk of bacterial endocarditis after cardiac surgery]

The risk of infective endocarditis (IE) after intracardiac surgery is dominated by the risk of IE on valvular prostheses. The reported prevalence of IE on prosthetic valves varies according to the chosen diagnostic criteria of IE and its timing. The risk of early IE is 0.4 to 1.3% and the linearized annual risk of late IE is about 0.5%. These values appear to be identical irrespective of the type and site of the prosthesis: the risk is higher in multiple valve replacement. In early IE, the commonest infecting organism is the staphylococcus: the bacteriological spectrum of late IE is the same as that of IE on native valves. The portal of entry is often detected in early IE but more rarely (50%) in late IE. The risk of IE in operated congenital heart disease is very low after surgery of left-to-right shunts or valvular stenosis; it is higher for patients with Tetralogy of Fallot and those with complex cyanotic disease, especially in cases with residual ventricular septal defects and with palliative surgery such as systemico-pulmonary anastomosis. The risk of IE on endocavitary catheters (pace-maker, defibrillator) after interventional cardiac procedures and after cardiac transplantation, seems to be very low. These results show that preventive measures against IE are only routinely required in prosthetic valve patients and after surgery of Tetralogy of Fallot and complex cyanotic cardiac disease.