Valve replacement for native valve bacterial endocarditis carries significant mortality, with preoperative complications and postoperative NYHA class being key prognostic risk factors, emphasizing the need for early surgical intervention.
Substantial mortality after endocarditis valve replacement warrants surgical timing caution; leaves open optimal thresholds in observational cohorts.
Between 1983 and 1922 70 patients of the author's institution underwent valve replacement for bacterial endocarditis of native valves. In 22 cases the source of infection could be identified. Among them the most frequent source of infection was dental manipulation (7 patients). The predominating causative microorganism was Streptococcus viridans followed by Staphylococcus aureus. Preoperative complications, the intraoperative finding of extensive destructions, and the histological finding of acute changes influenced significantly the occurrence of perioperative complications. 20 patients died (28.6% overall mortality), there were 9 perioperative deaths (perioperative survival 87.1%). The one-year survival was 73.8% the five-year survival 61.5%. Significant risk factors for the prognosis were preoperative complications, positive bacteriological result of the analyzed resected valves, perioperative complications, duration of the postoperative antibiotic treatment, and the postoperative NYHA functional class. Therefore one should intervene surgically before preoperative complications appear. Perioperative complications must by treated immediately, and an adequate postoperative antibiotic therapy must be guaranteed.
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Dehler et al. (1995) studied this question.
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