Surgery for infective endocarditis
Situations where urgent surgical assessment should be undertaken include (1):
- persistent pyrexia
- persistently positive blood cultures
- new murmurs
- recurrent emboli despite maximal antimicrobial therapy
- development of congestive cardiac failure - development of cardiac failure has a mortality of over 50% in patients with infective endocarditis managed with medical treatment alone (1)
- large vegetations
- persistent vegetation after a major systemic embolus
- evidence of an intracardiac abscess
- worsening renal failure may necessitate consideration of surgical intervention rather than continuation of medical therapy
Absolute indications for surgery include acute valvular regurgitation with pulmonary oedema, dehiscence of a prosthetic valve, and abscess formation (1).
Timing is critical. Ideally, infection should be eliminated beforehand but this has to be balanced against the risk of leaving the heart in a compromised haemodynamic state.
There is a 10 to 25% mortality for patients undergoing surgery during the acute phase.
Reference:
- Drugs and Therapeutics Bulletin (2002). 40 (4), 26-30.
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