Aims of the study : We reviewed our experience in infective acute endocarditis (IAE) of aortic valve over the last 24 years and tried to demonstrate the benefits of a radical surgical approach during the last decade.
Material and methods : Between 1979 and June 2003, 185 patients were operated for IAE of the aortic valve. Mean age was 55 years (range 20-80). 45 patients had prosthetic valve endocarditis (29 aortic, 5 mitral, 11 aorto-mitral)-and 140 patients had a native valve endocarditis. Indication for surgery was: septic embols, resistance to antibiotics treatment, heart failure, abscess, vegetations, and paraprosthesis leak. Offending microorganism were staphylococcus in 71 patients, streptococcus in 72, negative Gram in 19, and 12 patients had negative culture.
In 1991 we started to use aortic allograft and autograft as well as a radical excision for all infected tissue. We divided our patients in 2 groups: before 1991 (group I, 58 pts), and after 1991 ( groupe II, 127 pts). All patients in group I had mechanichal valve replacement In group II procedure consisted in 45 mechanical aortic valve replacements, 37 aortic allograft implantation, 18 biologic aortic valve replacement, 16 aortic valve repair, and 11 Ross procedure. 103 patients had a associated procedure in group II and 27 in group I. Destructed tissue was reconstructed with pericardium ( bovine or autologus) in 8 patients in group I and in 64 patients In group II.
Results : Hospital mortality was 17 % ( 34% group I, 16% group II). 2 patients in group I (4%) had early infection recurrence.
Mean follow up was 91 months +/- 54. 28 patients died in the late follow up ( 14 in each group), 19 from unknown cause, 4 of cancer, 3 sudden death, 2 stroke. Late endocarditis recurrence occured in 5 patients (3 in group I % and 2 in group II %), and needed surgical treatment in 4. Twelve patients underwent a reoperation 2 in group I ( 2 mitral valve replacement), 8 in group II (6 aortic valve replacement, 1 CABG, and 1 pericarditis).
Conclusions : Current surgical management of infective acute endocarditis with radical excision, pericardial reconstruction, and appropriate use of prosthetic material is benefic in term of hospital mortality and early and late recurrence.