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[Surgical treatment for active infective endocarditis]
S Fukunaga1, H Akashi, K Tayama
1Second Department of Surgery, Kurume University School of Medicine, Japan.
Abstract:
Between April 1975 and December 1995, 33 patients with active infective endocarditis underwent surgical treatment at our hospital. The location of diseased valve was shown as ; 18 in aortic, 11 in mitral, and 4 in aortic and mitral position. Of these, 14 patients had an annular abscess or mycotic aneurysm. All patients achieved antibiotic therapy previously, and predominant indication for operation was congestive heart failure. All patients underwent valve replacement. The reconstructive procedures for 14 patients with paravalvular involvement were as follows ; direct closure : 5 cases, direct closure+tilted prosthesis technique : 5 cases, and another 4 cases were, patch closure of VSP resulting from a septal abscess, patch closure+translocation, translocation, and reconstruction of annulas with pericardial patch. There were five (15.2%) operative and hospital deaths and actuarial survival rate was 81% and 61% at 5 and 10 years after operation. Including one who died early after operation, there were 5 cases with postoperative paravalvular leakage and its main cause were persistent infection. In conclusion, it considered that the principles of treating active infective endocarditis is to decide the optimal timing for operation, debride the infected tissue, and close the defect completely.
Insights
Surgical treatment for active infective endocarditis involving valve replacement, especially with annular abscesses, showed a 5-year survival rate of 81%. Key principles include optimal timing, debridement, and complete defect closure.
Area of Science:
- Cardiology
- Cardiac Surgery
- Infectious Diseases
Background:
- Active infective endocarditis (IE) poses significant risks, often necessitating surgical intervention.
- Valve dysfunction and complications like annular abscesses complicate management.
Purpose of the Study:
- To evaluate the surgical outcomes and long-term survival in patients with active infective endocarditis.
- To analyze the effectiveness of different reconstructive techniques for paravalvular involvement.
Main Methods:
- Retrospective analysis of 33 patients with active IE undergoing valve replacement between 1975 and 1995.
- Detailed review of valve pathology, surgical procedures, reconstructive techniques, and patient outcomes.
Main Results:
- 18 aortic, 11 mitral, and 4 combined aortic/mitral valve IE cases were treated.
- 14 patients had annular abscess or mycotic aneurysm; 5 (15.2%) experienced operative/hospital mortality.
- Actuarial survival rates were 81% at 5 years and 61% at 10 years; paravalvular leakage occurred in 5 cases, primarily due to persistent infection.
Conclusions:
- Optimal surgical timing, thorough debridement of infected tissue, and complete defect closure are crucial for managing active IE.
- Specific reconstructive techniques are vital for addressing paravalvular involvement and ensuring long-term success.