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Abstract
Background: Infective endocarditis is a diagnostic and therapeutic challenge that ultimately requires surgical intervention in 20% of all cases. Decisions regarding the indications for surgery, the timing, and the evaluation of the patient’s ability to withstand the contemplated operation are complicated decisions requiring appropriate guidelines and sound judgment based upon extensive clinical experience.
Patients and Methods: In this study we followed 20 patients diagnosed with definite infective endocarditis according to the modified Duke’s criteria and underwent cardiac surgery between June and December 2006. Clinical, laboratory and echocardiographic data were reported before surgery. Timing, type, indication for surgery and other intra-operative and post-operative variables were also reported.
Results: Rheumatic heart disease was the most common underlying cardiac risk factor (90% of patients), 75% of the patients had native valve endocarditis (NVE) and the remaining 25% had prosthetic valve endocarditis. The most common indications for surgical intervention were congestive heart failure (60%) and uncontrolled infection (60%). 90% of our patients were operated upon on elective basis. The most common post-operative complication was low cardiac output syndrome (15%) and new renal impairment. We had 6 mortalities (30%). The most common cause of in-hospital mortality was congestive heart failure and cardiogenic shock.
Conclusion: Preoperative renal impairment, abnormal white cell count, congestive heart failure and prosthetic valve endocarditis were associated with poor outcome. Further prospective studies with larger sample size are needed to study the actual prognostic value of other perioperative risk factors especially the benefit and optimal timing for surgical intervention