Surgical management of infective endocarditis.
OBJECTIVE
Although retrospective reviews evaluating the surgical management of infective endocarditis (IE) have been conducted in Europe and in the USA, few data exist regarding management of the condition in Canada. The study aim was to evaluate the surgical management of individuals with culture-positive active IE at a Canadian tertiary care university hospital.


METHODS
A retrospective analysis was performed of 74 patients (53 males, 21 females; mean age 56 +/- 14 years) with a preoperative diagnosis of acute IE between 1995 and 2003 at the Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia. Preoperative clinical variables evaluated included the Duke criteria for endocarditis, correlation between preoperative echocardiographic imaging and intraoperative findings, and postoperative morbidity and mortality.


RESULTS
Native valve endocarditis (NVE) was present in 60 patients, and prosthetic valve endocarditis (PVE) in 14. All patients met the Duke criteria for endocarditis. Correlation between preoperative transesophageal echocardiography (TEE) and surgical findings (vegetations 63%, abscesses 96%, leaflet perforation 100%) was superior when compared with preoperative transthoracic echocardiography (vegetations 43%, abscesses 75%, leaflet perforation 89%). There were low rates of postoperative morbidity (reoperation 8%, stroke 5%). Overall in-hospital mortality was 14% (seven NVE, 12%; three PVE, 21%).


CONCLUSIONS
Herein is presented the largest and most current case series of patients treated surgically for active IE. The results demonstrate excellent agreement between preoperative TEE and intraoperative surgical findings in the current era of surgical management of this condition.
Section of Cardiology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. umjassal@hotmail.com
Davinder S
DS
Jassal
Ansar
A
Hassan
Karen J
KJ
Buth
Tomas G
TG
Neilan
Chris
C
Koilpillai
Greg M
GM
Hirsch
D000328:Adult; D000368:Aged; D001022:Aortic Valve Insufficiency / Q000601:surgery; D002170:Canada; D004452:Echocardiography; D017548:Echocardiography, Transesophageal; D004697:Endocarditis, Bacterial / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000601:surgery; D016908:Gram-Positive Bacterial Infections / Q000601:surgery; D006333:Heart Failure / Q000601:surgery; D006349:Heart Valve Diseases / Q000382:microbiology* / Q000601:surgery*; D006350:Heart Valve Prosthesis / Q000009:adverse effects / Q000382:microbiology; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000601:surgery; D016459:Prosthesis-Related Infections / Q000000981:diagnostic imaging / Q000209:etiology; D012107:Research Design; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D014262:Tricuspid Valve Insufficiency / Q000601:surgery