Experience in surgical treatment for active endocarditis at Ho Chi Minh Institute

Abstract

Background: Surgical treatment for active infective endocarditis are always complex with many severe complications. Indications for surgery and the timing of surgery are still debated. 

Patient and Method: retrospected all infective endocarditis patients who were operated on at HCM Heart Institute from 1995 to 2020 and focused on the group of active infective endocarditis.

Results:

In total, there have 568 infective endocarditis patients were operated and among that active infective endocarditis were 138 patients (24.3%). In this group, according to pathology were as follows:15 on the native valve, 30 on the congenital defect, 56 on previous valvular heart disease, 2 post pace marker, and 35 on post valvular surgery. In most cases, pathogens of endocarditis were Streptococci spp (42%) and Staphyloccocus aureus (29,7%). Per operation, 100% of cases find out vegetations and 42 cases have an annular abscess.

The surgical procedure was as follows: vegetations ablation and radical repair of congenital defect:30; valve repair: 24; valve replacement: 77; electrodes ablation: 2, and  Bentall’s procedure: 5. Operative mortality was 11 cases (8%):  3 cerebral hemorrhages, 3 multi-organ failure, and 4 low cardiac output. The median time of follow-up was 11.2 years. Redo in the 1^st 3month and after 1 year caused by desinsertion ring or valve prosthesis were 12 cases and 4 cases, respectively.  Late death after 1 year was 6 (4 irreversible HF, 1 cerebral hemorrhage, and 1 sudden death). The rest cases have been stable.

Conclusion

Surgical treatment for active infective endocarditis has good results although the outcome is complex and the duration of hospital stay is very long. Early surgery for active infective endocarditis could solve radical infective lesions with a mortality rate acceptable.