Surgery for Infective Endocarditis

MORTALITY from infective endocarditis is 30% to 40%.1Although this is a great improvement over the 95% to 100% mortality in the preantibiotic period, it remains remarkably high. Major reasons for the high mortality include failure to prevent the disease, late recognition of the disease once present, and ineffective antibiotic treatment.2,3These latter two factors in the presence of virulent organisms may result in cardiac abscess formation, which decreases antibiotic effectiveness, in development of large vegetations that may be associated with emboli, and in structural cardiac damage with resultant congestive heart failure. All are associated with a high morbidity and mortality. The major cause of death is congestive heart failure that is usually due to severe aortic or mitral regurgitation or both. Valve replacement alleviates the hemodynamic load of valvular regurgitation; thus, cardiac surgery plays an important role in the care of patients with infective endocarditis. Indications for