Experience with surgical management of primary infective endocarditis: A collected review of 139 patients

One hundred thirty-nine patients with primary infective endocarditis who under-went open-heart surgery are analyzed; of these, 24 patients were operated upon at the University of Washington while the rest have been collected from the English literature. One hundred five patients were operated during the active stage and 34 patients in the healed stage. Seventy patients had pre-existent cardiac lesions before the onset of endocarditis. As a group, Streptococcus was the commonest infective organism followed by Staphylococcus. Congestive heart failure alone or with other conditions was the indication for surgery in 96 per cent of patients. Left-heart valves were involved in 135 patients, the aortic valve being the commonest site of infection. Prosthetic valve replacement alone or along with other procedures was done in 113 patients; in the remaining patients reconstructive procedures or homograft valve replacement was done. Over-all early and late mortality rates in the entire series were 25 and 8.6 per cent, respectively. The early mortality rate in the active stage was about 26.6 per cent while in the healed stage it was 11.7 per cent. Of 130 patients who left the operating room, 32 were reported to develop murmurs of regurgitation; of these 32 patients, 3 died of congestive heart failure and/or septicemia, 9 were reoperated upon, while the rest are stable. Two patients had residual infection with the original organism while an-other 2 patients developed reinfection with a new organism. Hemodynamic status is the most important determinant of timing of the operation in this disease. Once congestive heart failure starts due to tear or perforation of a leaflet during the course of active endocarditis, particularly of the aortic valve, surgery should be undertaken at an early date. It is suggested that an aggressive attitude with regard to early surgical intervention in these patients should further reduce the early mortality rate.