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Tirone E. David
George T. Christakis
Paulo R. Brofman
Christopher M. Feindel
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Ann Thorac Surg 1990;49:701-705
© 1990 The Society of Thoracic Surgeons


Articles

Heart valve operations in patients with active infective endocarditis

Tirone E. David, MD*, Joanne Bos, RN, George T. Christakis, MD, Paulo R. Brofman, MD, David Wong, MD, Christopher M. Feindel, MD

Division of Cardiovascular Surgery, Toronto Western Hospital and the University of Toronto, Toronto, Ontario, Canada

* Address reprint requests to Dr David, The Toronto Hospital, 200 Elizabeth St, EN13-219, Toronto, Ont, Canada M5G 2C4.

Sixty-two consecutive patients underwent heart valve operation for active infective endocarditis. There were 42 men and 20 women whose mean age was 49 years (range, 21 to 79 years). The infection was in the aortic valve in 37 patients, the mitral valve in 18, the aortic and mitral valves in 5, and the bicuspid valve in 2. Twenty-four patients had prosthetic valve endocarditis. Staphylococcus and Streptococcus were responsible for 86% of the infections. Annular abscess was encountered in 33 patients. Complex valve procedures involving reconstruction of the left ventricular inflow or outflow tract or both were performed in 31 patients. There were three operative deaths (4.8%). Predictors of operative mortality were prosthetic valve endocarditis, preoperative shock, and annular abscess. Patients were followed for 1 month to 130 months (mean follow-up, 43 months). Only 1 patient required reoperation for persistent infection. There were ten late deaths. Most survivors (96%) are currently in New York Heart Association class I or II. The 5-year actuarial survival was 79% ± 7%. These data demonstrate excellent results in patients with native valve endocarditis, and support the premise that patients with prosthetic valve endocarditis should have early surgical intervention.




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