Timing for surgical treatment in native infective endocarditis: A seven-year experience

Background. Early surgical intervention in infective endocarditis is performed only when there is persistence of sepsis, hemodynamic instability or when arterial embolism has occurred, otherwise a 4-week antibiotic therapy before surgery is considered necessary. Our 7-year experience in the surgical treatment of native endocarditis in 28 patients, is here revised focusing on the timing of surgery. Methods. Patients were retrospectively divided into group A (n. 16) with blood cultures that became negative before surgery and group B (n. 11) with blood cultures positive at the time of urgent surgery. One patient with constantly negative blood cultures was not assigned to any group. In group A antibiotic therapy was administered until 3 consecutive blood cultures became negative and the patients were then operated on the basis of echocardiographic findings after a mean duration of antibiotic therapy of 17.4±6.3 days. Results. Twenty-six patients out of 28 underwent replacement of the infected valve (mechanical bileaflets in 16 patients, porcine s tented in 7 and porcine stentless in 3). Valve repair was performed in 2 patients. Overall operative mortality was) 7.1% (2/28); death occurred in 2 patients of group B, operated, on for cardiogenic shock. Two/26 patients died (1 acute renal failure and 1 stroke) at a mean follow-up of 32.5±24.8 (range 3-95) months. Conclusions. Patients who underwent surgery for infective endocarditis after blood culture negativization showed no mortality and no recurrence of disease even if a 4 weeks antibiotic course was not completed. This experience suggests that earlier operations can be performed safely, lowering the incidence of hemodynamic impairment and arterial embolism.