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Active infective endocarditis: surgical approach

T Colombo1, M Lanfranchi, L Passini

  • 1A. De Gasperis Cardiac Surgery Division, Ente Ospedaliero Niguarda, Ca Granda, Milan, Italy.

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|January 1, 1994
PubMed
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Surgical valve replacement for active infective endocarditis (IE) showed high complication rates in both native and prosthetic valves. Early surgery is crucial to reduce mortality and reintervention risks in IE patients.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Infectious Diseases

Background:

  • Active infective endocarditis (IE) poses significant risks, often necessitating urgent surgical intervention.
  • Patients with IE frequently present with severe hemodynamic impairment and advanced New York Heart Association (NYHA) functional classes.
  • Both native and prosthetic valves are susceptible to IE, each presenting unique surgical challenges.

Purpose of the Study:

  • To evaluate the outcomes of surgical valve replacement in patients with active infective endocarditis.
  • To compare complication rates and risk factors for mortality between native and prosthetic valve IE.
  • To assess the impact of surgical timing and specific procedures on patient outcomes.

Main Methods:

  • A retrospective analysis of 65 surgical interventions in 61 patients with active IE from 1982 to 1991.

Related Experiment Videos

  • Patients were divided into two groups: native valve endocarditis (Group 1) and prosthetic valve endocarditis (Group 2).
  • All native valves and prostheses were replaced with mechanical valve prostheses; specific procedures were noted.

    • Main Results:

    • High rates of major preoperative complications (50% in Group 1, 44.8% in Group 2) and advanced NYHA classes (84% and 86%, respectively) were observed.
    • Hospital mortality was substantial (25% in Group 1, 31% in Group 2), with key risk factors including low cardiac output syndrome, cardiac failure, sepsis, and surgical timing.
    • Recurrence of IE and reintervention rates were significant, particularly in the prosthetic valve group (20% recurrence, 35% reintervention).

    Conclusions:

    • Surgical intervention for active IE is associated with considerable morbidity and mortality, irrespective of valve type.
    • Preoperative cardiac dysfunction and delayed surgical intervention are critical determinants of hospital mortality.
    • Prosthetic valve endocarditis appears to carry a higher risk of recurrence and reintervention compared to native valve endocarditis.