Cardiac Surgery in Bacterial Endocarditis

Open heart surgery has been performed at the Massachusetts General Hospital in 13 patients less than 6 months after the initiation of treatment for acute or subacute bacterial endocarditis. The endocarditis involved the aortic valve in 12 cases and a mitral valve prosthesis in the other. In two patients there was concomitant rupture of chordae tendineae of the mitral valve. One patient received no preoperative antibiotics, and four were still receiving their initial course of therapy at the time of surgery. The primary indication for surgery in all cases was progressive or intractable congestive heart failure. Ten underwent replacement of the aortic valve alone, two had both aortic and mitral valves replaced, and one had a mitral prosthesis replaced. Of the 13 patients, 10 are alive and doing well, although paraprosthetic insufficiency developed in three, two of whom required subsequent surgical repair. Three patients died, two in the early postoperative period, and one, 8 months after surgery from paraprosthetic regurgitation with hemolysis and heart failure. Antibiotics were given during and after surgery for as long as 6 weeks. In no case has recurrent sepsis been a problem. Our experience indicates that open heart surgery, when necessitated by progressive congestive heart failure due to valve destruction, can be safely and effectively performed during or shortly after treatment of bacterial endocarditis.