Surgical Management of Infective Endocarditis

Despite advances in diagnostic and pharmaceutical therapy, a significant subset of patients with infective endocarditis require surgical intervention. Details of 44 consecutive patients operated upon for infective endocarditis from December 1990 to January 1996 were analyzed retrospectively. Patient characteristics, presentation, risk factors and microbiological epidemiology are described. The mitral valve was most commonly affected. Nearly 70% of patients had an underlying cardiac abnormality. Early mortality was 11%. Streptococcus was most frequently isolated (40% of cases), Staphylococcus aureus was found in 28% of patients and it was associated with significantly higher mortality. Prosthetic valve endocarditis accounted for 14% of cases and it was associated with significantly earlier intervention as well as a high mortality. Overall survival at 5 years was 84% with an event-free survival of 79%. Surgical intervention when valve failure develops or medical therapy is unsuccessful, is lifesaving and can be associated with acceptable morbidity and mortality. Patients with Staphylococcus aureus infection and those with prosthetic valve endocarditis require aggressive therapy including early referral for surgery.