Skip to main content
NCBI home page
The Texas Heart Institute Journal logoLink to The Texas Heart Institute Journal
. 1987 Dec;14(4):401–410.

Infective Endocarditis: Diagnosis, Treatment, and Mortality, as Related to Surgical Timing and Infectious Organism

Abdulla A Attum 1,2, Zahi Masri 1,2, Sam F Yared 1,2, G Stephan Johnson 1,2, Roland Girardet 1,2, Allan M Lansing 1,2
PMCID: PMC324765  PMID: 15227297

Abstract

To evaluate the timing of surgical treatment in infective endocarditis and to determine the relationship between the risk of mortality and the species of infectious organism, we reviewed a consecutive series of 65 cases involving patients with infective endocarditis who had been treated over a 17-year period. The patients included 41 males and 24 females, who ranged in age from 6 to 85 years (mean, 39.3 years). Forty-five had native valve endocarditis, 14 had prosthetic valve endocarditis, and six had endocarditis associated with congenital heart defects.

Fifty-two patients underwent valve replacement, which was associated with an overall operative mortality of 19%. Those who underwent valve replacement during the early active stage (first 3 weeks) of infection had a higher mortality rate than those who had surgery either during the late active stage (second 3 weeks) of infection or after 6 weeks of antibiotic therapy. S. aureus and Pseudomonas organisms were responsible for the most deaths.

On the basis of this study, we recommend that, when cardiovascular function permits, patients who are hemodynamically stable and free of emboli should receive 4 to 6 weeks of antibiotic therapy before undergoing surgical treatment. In contrast, patients with high-risk organisms are more likely to survive if subjected to early surgical intervention. (Texas Heart Institute Journal 1987; 14:401-410)

Keywords: Endocarditis, aortic valve

Keywords: mitral valve

Keywords: heart valve prosthesis

Full text

PDF
401

Images in this article

406Image
on p.406

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alsip S. G., Blackstone E. H., Kirklin J. W., Cobbs C. G. Indications for cardiac surgery in patients with active infective endocarditis. Am J Med. 1985 Jun 28;78(6B):138–148. doi: 10.1016/0002-9343(85)90376-6. [DOI] [PubMed] [Google Scholar]
  2. Baumgartner W. A., Miller D. C., Reitz B. A., Oyer P. E., Jamieson S. W., Stinson E. B., Shumway N. E. Surgical treatment of prosthetic valve endocarditis. Ann Thorac Surg. 1983 Jan;35(1):87–104. doi: 10.1016/s0003-4975(10)61436-1. [DOI] [PubMed] [Google Scholar]
  3. Cukingnan R. A., Jr, Carey J. S., Wittig J. H., Cimochowski G. E. Early valve replacement in active infective endocarditis. Results and late survival. J Thorac Cardiovasc Surg. 1983 Feb;85(2):163–173. [PubMed] [Google Scholar]
  4. Karchmer A. W. Staphylococcal endocarditis. Laboratory and clinical basis for antibiotic therapy. Am J Med. 1985 Jun 28;78(6B):116–127. doi: 10.1016/0002-9343(85)90374-2. [DOI] [PubMed] [Google Scholar]
  5. Lewis B. S., Agathangelou N. E., Colsen P. R., Antunes M., Kinsley R. H. Cardiac operation during active infective endocarditis: results of aortic, mitral, and double valve replacement in 94 patients. J Thorac Cardiovasc Surg. 1982 Oct;84(4):579–584. [PubMed] [Google Scholar]
  6. Nelson R. J., Harley D. P., French W. J., Bayer A. S. Favorable ten-year experience with valve procedures for active infective endocarditis. J Thorac Cardiovasc Surg. 1984 Apr;87(4):493–502. [PubMed] [Google Scholar]
  7. Paneth M. Native and prosthetic valve endocarditis. Thorac Cardiovasc Surg. 1982 Dec;30(6):362–364. doi: 10.1055/s-2007-1022425. [DOI] [PubMed] [Google Scholar]
  8. Perry L. S., Tresch D. D., Brooks H. L., Lepley D., Olinger G. N., Bonchek L. I., Johnson G. Operative approach to endocarditis. Am Heart J. 1984 Sep;108(3 Pt 1):561–566. doi: 10.1016/0002-8703(84)90424-1. [DOI] [PubMed] [Google Scholar]
  9. Santinga J. T., Kirsh M., Fekety R. Factors affecting survival in prosthetic valve endocarditis. Review of the effectiveness of prophylaxis. Chest. 1984 Apr;85(4):471–475. doi: 10.1378/chest.85.4.471. [DOI] [PubMed] [Google Scholar]
  10. Vejlsted H., Baandrup U., Szczepanski K., Eyjolfsson K., Henningsen P., Albrechtsen O. Surgical treatment of bacterial endocarditis. Thorac Cardiovasc Surg. 1982 Dec;30(6):358–361. doi: 10.1055/s-2007-1022424. [DOI] [PubMed] [Google Scholar]
  11. Westaby S., Oakley C., Sapsford R. N., Bentall H. H. Surgical treatment of infective endocarditis with special reference to prosthetic valve endocarditis. Br Med J (Clin Res Ed) 1983 Jul 30;287(6388):320–323. doi: 10.1136/bmj.287.6388.320. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Wilson W. R., Jaumin P. M., Danielson G. K., Giuliani E. R., Washington JA I. I., Geraci J. E. Prosthetic valve endocarditis. Ann Intern Med. 1975 Jun;82(6):751–756. doi: 10.7326/0003-4819-82-6-751. [DOI] [PubMed] [Google Scholar]

Articles from Texas Heart Institute Journal are provided here courtesy of Texas Heart Institute

RESOURCES