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The Journal of Thoracic and Cardiovascular Surgery, Vol 70, 509-518, Copyright © 1975 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association

ARTICLES

The case for early surgical treatment of left-sided primary infective endocarditis. A collective review

JY Jung, SB Saab and CH Almond

Sixteen cases of infective endocarditis requiring valve replacement with a prosthesis are described. The indication for surgery was intractable congestive heart failure in all. Fourteen patients underwent aortic valve replacement, with five hospital deaths secondary to cardiac decompensation and one late death related to recurrent periprosthetic insufficiency. Two patients who required mitral valve replacement did well, with no early or late deaths. A collected review of 293 cases of left-sided primary infective endocarditis reported in the English literature confirms the feasibility, advisability, and life- saving potential of urgent surgical intervention in patients with persistent or progressive congestive heart failure, irrespective of the activity of the infective process or the duration of antibiotic therapy. All infected tissue should be resected, and Teflon bolsters should be used to minimize the incidence of periprosthetic leaks. The incidence of prosthetic infection is minimal, contrasted with the fatal potential of procrastination to achieve microbial cure.

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