Surgical intervention in staphylococcal endocarditis.

Uncomplicated endocarditis is cured by medical treatment at a rate of 80% (75% 5-year survival rate). If incompensated, only 12% has shown to be curable without surgery. With valve replacement, on the other hand, the rate of success will be 80%. Of those surgically treated cases, less than 10% will develop recrudescent infection. Left heart vegetations predict the risk of congestive heart failure and/or embolism. It is assumed that 7-10 days of efficient antibiotic therapy without effect should lead to surgery. We have made valve replacement in six cases during recent years in staphylococcal endocarditis. The main indication for operation was congestive heart failure, and the valve used was the Björk-Shiley tilting disc. All patients had vegetations on the leaflets. One patient had a mitral insufficiency, and the other five had aortic insufficiency. Two cases were lost within four months after surgery. In general, indications for valve replacement are heart incompensation or vegetations on leaflets.