Chirurgie précoce dans l'endocardite infectieuse. Étude rétrospective à propos de 30 cas

Abstract

Aim The aim of this study is to stress the interest of the early surgery in infective endocarditis (IE), its indications and prognostic implications. Methods It is a retrospective descriptive study of 30 cases (29 men and 1 woman with an average age of 35 ± 12 years) with IE underwent surgery management in the acute phase between September 1993 and June 2005. Results They were 25 rheumatic lesions, 2 aortic bicuspids and 3 mechanical valves prosthesis. Four twenty-six percent of the patients were operated for hemodynamic deterioration and 10% for embolic complication. We report 3 cases (that is to say 10%) of IE late form on prosthesis. Three patients died in the first post operative month by respectively total desinsertion of mitral prosthesis on peroperative, 1 septic shock at the 13th post operative day and 1 tamponade at the 14th postoperative day. On 72 months an average follow-up, 26 were controlled regularly: 25 evolved favourably and 1 died in third postoperative year (severe heart failure). Conclusion A high early surgery rate is related to good long term results and does not increase in hospital mortality. The reduced mortality was particularly evident among patients with moderate to severe congestive heart failure.