Infective endocarditis: a better outcome after surgery during the active phase

Excerpt

Very few studies document long term survival in infective endocarditis. This prospective study, which excluded intravenous drug abusers, recorded both 1 and 5 year mortality. The investigators found that a higher proportion of patients (51%) underwent surgery during the active phase of the disease (when symptoms were still pronounced but the condition was stable) than those reported in other series. A delay in diagnosis and consequently in the initiation of antimicrobial treatment was associated with higher complication rates (83%), thus requiring a greater number of surgical procedures. Unlike previous studies, the most frequent cause of early mortality was not heart failure or persistent sepsis but complications in emergency surgery. However, there was no significant difference in mortality between patients following medical treatment (20%) or those undergoing elective surgery (21%). Overall survival at 5 years (71%) was higher than in other series. In conclusion the results seem to indicate that elective surgery in the active phase of infective endocarditis improves long term survival rate without increasing early mortality. Additionally, in cases of responsive infective endocarditis with absence of poor prognostic factors, medical treatment also offers favourable long term results. …