Timing of surgery in patients with acute infective endocarditis

Surgical intervention in patients with active infective endocarditis is generally considered as indicated in few high-risk patients who have developed severe complications such as heart failure, persistent septicemia or recurrent arterial embolism, but the question of when to intervene is still subject to discussion.

Retrospective study.

Cardio-Thoracic Surgery Unit, University clinic. PATIENTS, INTERVENTIONS AND RESULTS: From 1984 to 1994, 130 patients (87 male, mean age 43.2 +/- 12.7 years) underwent heart valve replacement or reconstruction for infective endocarditis of native or prosthetic valves. 89 of them had acute infection requiring urgent surgical treatment. Over-all operative mortality was 12.3%. Certain preoperative factors were investigated regarding their influence on postoperative death. Statistical analysis revealed functional class according to NYHA as well as extravalvular involvement of the infection as significant risk factors or mortality. Emergency operation was not significantly associated with increased operative mortality, neither were the causative organism, a history of arterial embolism or persistent septicemia.

In active infective endocarditis the optimal time to perform surgery is before the onset of severe end-stage heart failure or spread of the infection to extravalvular tissue. If one of these complications is imminent, urgent intervention is indicated.