Aortic Infective Endocarditis Research Articles

Valve replacement in patients with active infective endocarditis.

Eleven of 138 patients with infective endocarditis (IE) who underwent cardiac valve replacement for IE during a 12 1/2-year period had active IE. Eight of the 11 (all with aortic IE) had positive blood cultures within 48 hours preoperatively; six of the eight had positive Gram stains and cultures of the excised cardiac tissue. All 11 patients had Class IV cardiac functional disability (New York Heart Association classification) at the time of surgery. Staphylococci (three patients with Staphylococcus aureus and one with S. epidermidis) were the most frequent isolates. Three patients died; two of these three deaths occurred in patients who had a sudden onset preoperatively of severe aortic regurgitation and heart failure. In one patient (S. epidermidis infection) prosthetic valve endocarditis developed. Cardiac valve replacement may be performed successfully in patients with active IE even when blood cultures are positive in the immediate perioperative period. The hemodynamic status of patients with IE should be the determining factor in the timing of cardiac valve replacement, rather than the activity of the infection or the length of preoperative antimicrobial therapy. A radical surgical procedure may be necessary in patients with myocardial or aortic abscesses in whom conventional aortic valve replacement is not possible.

HOMOGRAFT REPLACEMENT OF THE AORTIC VALVE: Immediate Results and Follow-up

Homograft replacement of the aortic valve was performed on 146 patients between 1964 and December, 1966. An additional surgical procedure was necessary in 50 patients: mitral valvotomy in 25, repair or replacement of the mitral and tricuspid valves in 22, and closure of a ventricular septal defect in 3. Mortality during the initial hospital admission was 24%. 101 patients are alive one to four years after surgery. Postoperative aortic regurgitation developed in more than half the patients but was usually trivial. It was of hæmo-dynamic importance in 18 patients, 7 of whom are controlled on medical treatment. There have been no cases of systemic embolism, hæmolytic anæmia, or sudden death. Of the 109 patients discharged from hospital with aortic homograft valves the result is considered excellent in 35, good in 38, satisfactory in 11, and poor in 10. Prosthetic replacement of the graft has been successfully performed in 5 patients. There have been 10 deaths since discharge from hospital; aortic regurgitation and infective endocarditis were the principal causes of late deaths.