Surgical treatment of active infectious endocarditis: a study of 361 surgical cases

• Autor(a) principal: Dias,Altamiro Ribeiro
• Data de Publicação: 2003
• Outros Autores: Pomerantzeff,Pablo M., Brandão,Carlos Manoel A., Dias,Ricardo Ribeiro, Grinberg,Max, Lahoz,Eliecer Villamizer de, Oliveira,Sérgio Almeida de
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Brazilian Journal of Cardiovascular Surgery (Online)
• Texto Completo: http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0102-76382003000200010
• topic: Endocarditis/surgery; Heart valves/surgery; Abscess/heart valves

OBJECTIVE: To report on the experience achieved with the surgical treatment of 361 patients with acute infectious endocarditis who were operated on in the Heart Institute of the University of São Paulo. METHOD: The ages of the patients ranged from 3 to 81 years, with an average age of 38 ± 8.3 years. There were 230 male patients. It was possible to identify the etiologic agent in 311 (86.20%) patients. The diagnosis of acute infectious endocarditis was obtained by clinical, echocardiographic and microbiological evaluations. Two hundred and five patients had lesions of heart valves and 156 patients had lesions of cardiac valvular prostheses. Ninety had annular abscesses and 11 had fistulae. Of the group of diseased native valves, 104 (50.73) were operated on because of severe heart failure and 87 (42.44%) because of progressive sepsis. All natural aortic valves (136) were replaced by artificial valves. There were 107 diseased native mitral valves. In this group partial resections of infected tissue (vegetations) were carried out in 13 patients while maintaining the valvar apparatus. Of the 16 infected tricuspid valves, 8 were replaced. All the prostheses were substituted. The abscesses were cleaned and closed when their diameter was less than 10 mm. The larger abscesses were cleaned and closed with a pericardial graft, which was the support for the artificial valve. RESULTS: There were 75 (20.78%) hospital deaths, most of which caused by heart problems and their complications. There were 15 cases of postoperative endocarditis, 10 of which were re-operated on. The late follow-up showed good functional and clinical results, with 222 (77.62%) patients as NYHA Class I. CONCLUSIONS: When indicated, the surgical treatment must be instituted as early as possible. All diseased and infected tissue must be removed to achieve good results.