Timing of surgical treatment for active native value endocarditis

The aim of the study was to assess the optimum timing of surgical treatment for the active phase of native valve endocarditis. A retrospective study was conducted of the records of patients who had undergone aortic and/or mitral valve replacement for active native valve endocarditis during 1979-94 at Kinki University Hospital. Thirty-three patients with active infective endocarditis of the native valves were treated surgically. Their mean age was 45.4 years (range 11-71). The infective organism was streptococcus in 9 cases, Staphylococcus aureus in 8, and enterococcus in 4 cases. Blood cultures were negative in 9 cases. Of the patients infected with Staphylococcus aureus, 3 died soon after the operation and 1 died later during hospitalization. These 4 patients had been treated medically more than 2 weeks before operation. Another patient who was also treated medically more than 2 weeks before surgery survived. In contrast, all 3 patients infected with Staphylococcus aureus who were operated on within 2 weeks after the onset survived. No early or in-hospital deaths were documented among patients infected with organisms other than Staphylococcus aureus. Among patients who had suffered preoperative embolic episodes, the time from the initial pyrexia to the embolic event was clearly shorter in those infected with Staphylococcus aureus than in those infected with other organisms. Among the former group, 5 out of 6 patients suffered an embolism within 2 weeks of the onset of pyrexia and the remaining 1 within 3 weeks. Thus, in patients presenting with active native valve endocarditis caused by Staphylococcus aureus, surgical treatment should be performed as soon as possible after the onset of pyrexia, preferably within 2 weeks or as soon as the infective organism is identified as Staphylococcus aureus.