The Annals of Thoracic Surgery, Vol 32, 347-350, Copyright © 1981 by The Society of Thoracic Surgeons
Early operative intervention in aortic bacterial endocarditis
RL Prager, MD Maples, JW Hammon Jr, GC Friesinger and HW Bender Jr
Since 1974, 14 patients have required valve replacement for native aortic
valve bacterial endocarditis at Vanderbilt University Medical Center. There
were 7 male and 7 female patients ranging from 11 to 65 years old. Nine of
the patients were less than 27 years old. All patients had congestive heart
failure as a complication of the bacterial endocarditis and were in New
York Heart Association (NYHA) Functional Class III or IV. Two patients were
seen initially with arrhythmias, 3 had episodes of septic emboli, and 1
patient was operated on immediately after sustaining a cardiac arrest.
Echocardiogram was utilized in 9 patients, and cardiac catheterization was
performed in 6 patients who were suspected to have concomitant mitral valve
or coronary artery disease. All patients were operated on within two weeks
after the institution of antibiotic therapy, and there were no operative or
early postoperatively deaths. Preoperative blood cultures were positive in
13 patients, with streptococcus cultured in 6 patients and staphylococcus
in 4. Escherichia coli and enterococcus were the other pathogens cultured.
All patients received antibiotics intravenously for a total of six weeks.
There has been 1 late postoperative death, which occurred 2 months
following operation in a patient with myocardial failure unresponsive to
treatment. Two patients underwent reoperation, 1 because of a persistent
aorto-right ventricular fistula and the second because of paraprosthetic
aortic regurgitation. Nine patients are now in NYHA Functional Class I and
4 are in Class II.
