Early surgery in infective endocarditits: Indications and short terms results

Abstract

Infective endocarditis (IE) is a complex disease whose prognosis is still severe despite diagnostic and therapeutic advances. Urgent or early surgery is a mainstay of the management of complicated IE. To study the indications, the interest and the results of early surgery in complicated IE in our study population. We conducted a retrospective and descriptive study of a records of 135 patients hospitalized in La Rabta hospital during period between 2000 to 2014 for a certain IE. Then we reported epidemiological,clinical and therapeutic data of early operated patients. Quantitative variables are expressed as means ± standard deviations. Comparisons between groups were carried out using student's t -test or the Chi 2 test depending of the type of variable. We have identified 54 cases (40%) of complicated IE among the general population ( n = 135) of IE. Average age is 41.6, with a male predominance and the sex ratio is 1.75. Blood cultures were negatives in two third of cases. Streptococcus is the most frequently isolated germ found in 46%. Echocardiography showed vegetations in 100% of cases, abscesses in 45.5%, valvular perforation in 13% and prosthetic dehiscence was observed in half of the patients. Early surgery was indicated because of complications: it was hemodynamic in 30%, septic in 20%, embolic in 10% and mixed in 40% The early postoperative complications were mainly bleeding and infections rated each in 14% of cases. Recurrence of IE was observed in 9% of patients with a mean time of occurrence estimated to be 12 days. The mortality rate is 13%. IE remains a serious disease with a high rate of mortality despite advances in surgery and intensive care.