Operative treatment of active endocarditis.

During the past decade 44 patients with active endocarditis, defined as valvular infection requiring operative intervention before completion of a planned course of antibiotic therapy, have been treated at Stanford University Medical Center. Twenty-seven patients had infection of a native valve (primary endocarditis) and 17 had infection of a previously implanted intracardiac prosthesis. In 91 per cent of cases urgent valve replacement was dictated by rapid hemodynamic deterioration and in the remainder by recurrent macroemboli or persistent sepsis. Various species of Streptococcus were the most common organisms encountered, followed by Staphylococcus aureus. Unusual bacteria were mostly limited to patients with prosthetic infections; Candida was seen in both groups. Aortic valve replacement was required in 80 per cent of patients. Operative mortality rates were 30 per cent in the group with primary disease and 24 per cent in the group with disease of the prosthetic valve. Most deaths were attributable to multiple system complications generated preoperatively and were unrelated to duration of preoperative antibiotic administration. Five-year survival rates for operative survivors were 68 per cent (primary) and 54 per cent (prosthetic). This experience illustrates the potential therapeutic benefit of operative intervention during active infective endocarditis complicated by severe heart failure or other life-threatening events.