Surgical Treatment For Severe Acute Infective Endocarditis

Objective:With the aging of our society, growing number of artificial valve implantation, increased bacteremia due to all kinds of medical intervention procedures and the improving of infective endocarditis diagnostic technology, the morbidity of IE keeps increasing. As IE is such a progressively developing disease, how to treat severe acute infective endocarditis become a difficult problem for cardiac surgeeon. In this study, we investigated the effect of early surgical treatment for severe acute infective endocarditis (IE) in short and long-term.Methods:Retrospective analysis of 43 severe acute infective endocarditis (IE) patients who accept cardiac surgery from January 2005 to March 2010 at the First Affiliated Hospital, School of Medicine, Zhejiang University. All patients' EuroSCORE≥6 points and accepted acute or subacute surgery.41 patients suffered primary infective endocarditis, the other two patients had prosthetic endocarditis.15 cases were mitral valve infection and 2 of them were prosthetic valve infection after mitral valve replacement.15 cases were aortic valve infection., while both mitral and aortic valves were involved in 13 cases. During surgery, seriously damaged valve was found in 23 cases. Abscess on aortic annulus and adjacent structure was found in 11 cases. mitral valve annulus abscess in 5 patients, abscess in 3 cases under the mitral valve device, accompanied by tricuspid valve vegetations 2 cases. All patients had valvular vegetations formed.Results:There are 3 early postoperative deaths,, mainly due to low cardiac output syndrome, multiple organ failure. Followed up for 4 months to 5 years (2.4±0.5)..1 case of late death, because of intracranial hemorrhage.Conclusion:For severe acute infective endocarditis (IE) patients, early surgical intervention is the key to postoperative infection control and better prognosis of the disease. It does not increase the total mortality of infective endocarditis, and is better than conservative treatment. The elimination of vegetation and repairing of structural defects in the surgery is essential for successful outcome.