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[Surgical treatment of active infective endocarditis]
1First Department of Surgery, Yokohama City University School of Medicine, Japan.
Insights
Surgical treatment for infective endocarditis during active infection poses a high embolism risk. Careful monitoring for emboli is crucial in these patients post-surgery.
Area of Science:
- Cardiology
- Infectious Diseases
- Cardiac Surgery
Background:
- Surgical intervention for infective endocarditis (IE) is complex.
- Understanding risks associated with active-phase surgery is critical for patient outcomes.
Observation:
- Eleven patients with active IE underwent surgery between 1978-1990.
- Indications included uncontrolled infection (7 patients) and progressive heart failure (4 patients).
- Operative findings revealed vegetations in all cases and valve perforations in six.
Findings:
- No operative deaths occurred.
- Five perioperative complications arose in patients with uncontrolled infection, including prosthetic valve endocarditis and mycotic aneurysms.
- Patients operated on for progressive heart failure experienced no complications.
Implications:
- Active IE surgery, particularly for uncontrolled infection, carries a significant risk of embolic events.
- Close monitoring for emboli is essential for patients undergoing surgery during the active phase of IE.
- Timely surgical intervention for heart failure in IE patients appears to have a lower complication rate.
Abstract:
From January, 1978, through December, 1990, surgical treatment for active infective endocarditis was performed in 11 patients. There were 8 men and 3 women who ranged in age from 19 to 54 years with a mean age of 38.8 years. Two patients had ventricular septal defects and 1 patient had rheumatic valve disease. In all patients, the infecting organism was isolated from blood, including streptococcus in 7, staphylococcus in 2, and gram-negative rods in 2. The indication for operation at the active phase was uncontrolled infection in 7 and progressive heart failure in 4. The operation was performed at 7 to 150 days with a mean of 53 days after diagnosis. Operative findings showed vegetations in all cases and perforations of the valve in 6. There were no operative deaths. Perioperative complications developed in 5, whose indication for operation was uncontrolled infection. Complications consisted of 1 prosthetic valve endocarditis, 1 pulmonary suppuration, 1 ruptured mycotic aneurysm of the hepatic artery, 1 ruptured mycotic aneurysm of the popliteal artery, and 1 pyogenic spondylitis. All were successfully treated surgically or with antibiotic therapy. There were no complications in patients whose indication for operation was progressive heart failure. We conclude that the risk of embolism is high in patients undergoing surgery at the active phase of infective endocarditis because of uncontrolled infection; thus, such patients should be carefully monitored for emboli.