Background. A retrospective study analysing effects of surgical treatment of active infective endocarditis was
performed in our centre between January 1998 and December 2005.
Methods and Results. 57 consecutive patients with infective endocarditis underwent surgical intervention in active
phase of infection (fulfilment of Durack diagnostic criteria, persisting elevation CRP at the time of cardiac surgery,
indications for surgery according to actual guidelines of the Czech Society of Cardiology). Male to female ratio was
38:19. The patients’ mean age was 52.5 years without any significant differences among men and women. The most
frequent causative agents were staphylococci – 28.1 % and streptococci – 19.3 %. 26 cases of aortic valve
involvement were the most frequent, followed by 21 cases of mitral endocarditis, and 7 cases were both aortic and
mitral valve endocarditis. 3 cases of tricuspid endocarditis were also observed. Native valve endocarditis prevailed
over the prosthetic ones – 49 versus 8. Surgery was most often performed using a mechanical prosthesis (45 cases),
bioprostheses were implanted in 13 patients and 6 patients underwent mitral or tricuspid valve repair operation. In 1
patient, the procedure was complemented with mitral valve annuloplasty, and in 5 patients, the operation was
completed with tricuspid annuloplasty - because of significant regurgitation of other aetiology. Coronary artery
bypass surgery (at the same time) was necessary in 9 patients. Surgery was followed by a significant shift from classes
III and IV to classes I and II of NYHA classification. Relapsing or recurrent endocarditis developed in 7 %. Thirtyday
mortality of patients who had undergone surgery for active infective endocarditis was 15.8 %, 9 patients died.
During follow up period 7 patients died, the overall mortality was 28.1 %. Survivors were followed up for 0.5-90
(median 40) months.
Conclusions. Operation for active infective endocarditis carries a relatively higher mortality in comparison with
elective surgery. Nevertheless, this is acceptable because the operation in active phase is enforced by life-threatening
complications and it also reduces assumed mortality at conservative therapy. Our results are comparable with data
from other studies.
infective endocarditis, surgery, valve replacement, valve repair.