The importance of early surgical intervention for patients with active infective endocarditis

Background: The duration of medical treatment in a patient with infective endocarditis and timing of surgery can be a difficult clinical decision. This study was undertaken to determine whether specific preoperative variables were independent risk factors for operative mortality and establish long term prognosis for patients undergoing valvular surgery for endocarditis. Methods: Two hundred and seventeen consecutive patients with active infective endocarditis between 1972 and 1997 were studied. The 152 males (70%) and 65 females (30%) with mean age 53 (6-80) underwent a total of 227 valve replacements or repairs. Native valve endocarditis (NVE) was present in 162 (71%) and prosthetic valve endocarditis (PVE) in 65 (29%). The valve position infected was the aortic alone in 115 (51%), mitral alone in 71(31%), and others in 41 (18%). Results: The overall early (30 day) mortality was 9.7% ((21/217). For patients with NVE the early mortality was 8.0% (13/162) and for those with PVE 12.3% (8/65) (p=0.3). Preoperative risk factors for early mortality, as determined by multiple logistic regression analysis, included increased duration of antibiotic treatment prior to surgery, younger age and poor left ventricular function (p<0.05). Kaplan-Meier survival, including early mortality, was 74.2 % ± 3.1(1SE) at 5 years, 63.9% ± 4.0 at 10 years and 48.3% ± 6.7 at 15 years. Freedom from reoperation for endocarditis was 96.1% ± 1.5 at 5 years and 94.4% ± 2.2 at 10 and 15 years. Conclusions: Immediate outcome following surgery for infective endocarditis is improved with an early operation. Relatively good long term survival can be expected in patients surviving the initial post operative period and in our experience reoperation for recurrent infection is rare.