- Paper Report
- Open Access
Infective endocarditis: a better outcome after surgery during the active phase
- Gerardo Amilivia1
© Current Science Ltd 2000
- Published: 19 September 2000
- Infective endocarditis
To determine the clinical features and long term prognosis of infective endocarditis in patients who were not intravenous drugs abusers.
Prospective series with 138 consecutive cases of infective endocarditis diagnosed and treated from January 1987 to March 1997
Early prosthetic valve endocarditis (PVE) was diagnosed when infection occurred in the first two months following heart surgery, while intermediate and late PVE were diagnosed when infection developed at 2-12 months and more than one year, respectively
All patients received antibiotic treatment for 4-6 weeks
Surgery was indicated in the following circumstances: moderate to severe heart failure, significant valve regurgitation, repeated major emboli, severe mechanical complications, in cases of early PVE, endocarditis on pacemaker leads, and in cases of persistent sepsis
Emergency surgery was that which could not be postponed for more than 24 h. Elective surgery could be delayed for longer time periods without risk to the patient
All survivors at the in-hospital phase were included in the prospective follow up
Death occurring during the six weeks post-diagnosis was considered early mortality
Infective endocarditis was diagnosed in 124 out of 138 cases. Native valve endocarditis (NVE) accounted for 69% of the cases and PVE 31%. A presumed portal of entry was identified for 38% of the cases. Staphylococcus was the organism most frequently responsible for NVE cases, while streptococcal infection was the most common in the PVE cases. Echocardiography detected vegetations in 86% of the cases (59% with transthoracic echocardiography and 92% with transoesophageal echocardiography [P < 0.01]) and this difference was greater in the PVE group than in the NVE group. Cardiac and extracardiac complications were a frequent finding (83%). Surgery was carried out in the active phase in 50% of the cases with NVE and 53% of the cases with PVE. Elective surgery predominated over emergency procedures (29% vs 22%). The highest mortality rate (50%) was registered among early PVE. Prognosis was not affected by the type of infective endocarditis (NVE or PVE) or by the site and causal agent. Overall survival was 75% at 1 year and 71% at 5 and 10 years (overall survival for NVE was 78% at 1 year and 76% at 5 years, and for PVE it was 67% and 59%, respectively [P < 0.01]). Follow-up event free survival at 1 year was 92%, and 82% at 5 and 10 years. One and 5 year survival rates for survivors past active phase were 98% and 96% for cases of NVE, while in cases of PVE they were 90% and 82%, respectively (P < 0.05) .