Infective endocarditis.
BACKGROUND
Infective endocarditis continues to pose a therapeutic challenge to treating clinicians. We believe that the successful management of endocarditis mandates a thorough understanding of the risk factors for adverse outcomes and a co-ordinated team approach.


METHODS
Between the years 2000 and 2009, 85 patients required surgery for infective endocarditis, with a total of 112 infected valves being treated surgically. Data was analysed to determine factors significantly associated with morbidity and mortality.


RESULTS
The mean age was 50.5 years. Nine (10.5%) of these patients had Prosthetic Valve Endocarditis, the remaining 76 (89.5%) had Native Valve Endocarditis. Twenty-nine percent of patients were NYHA 4 pre-operatively, 15% of patients were haemodynamically unstable requiring inotropic support, 34% were persistently febrile despite antibiotic therapy, and 48% had suffered any embolic event, 20% suffered cerebral emboli. The commonest causative organism in our series was Staphylococcus Aureus (54.1%) with 2.3% of cases being due to MRSA. The second commonest organism isolated was Streptococcus spp. at 21.1%. Operative mortality was 12.9%, of which on-table mortality was 2.2%. Mean follow-up was 56 months (range 1-151). Early recurrence rates (<3 months) were 2.3%. Late recurrence was 7.0%. The pre-operative factors associated with increased mortality were age over 65, inotropic requirement, uncontrolled sepsis and cerebral emboli. We summarise our experience and recommendations for a team approach to the management of infective endocarditis.
Department of Cardiothoracic Surgery, Royal Perth Hospital, Perth, Western Australia, Australia.
B
B
Dunne
Department of Cardiothoracic Surgery, Royal Perth Hospital, Perth, Western Australia, Australia.
T
T
Marr
Department of Cardiothoracic Surgery, Royal Perth Hospital, Perth, Western Australia, Australia.
D
D
Kim
Department of Cardiothoracic Surgery, Royal Perth Hospital, Perth, Western Australia, Australia.
D
D
Andrews
Department of Cardiothoracic Surgery, Royal Perth Hospital, Perth, Western Australia, Australia.
M
M
Edwards
Department of Cardiothoracic Surgery, Royal Perth Hospital, Perth, Western Australia, Australia.
C
C
Merry
Department of Cardiothoracic Surgery, Royal Perth Hospital, Perth, Western Australia, Australia.
R
R
Larbalestier
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D004696:Endocarditis / Q000382:microbiology / Q000401:mortality / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000382:microbiology / Q000401:mortality / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000401:mortality / Q000601:surgery; D013211:Staphylococcus aureus; D013290:Streptococcal Infections / Q000401:mortality / Q000601:surgery; D013291:Streptococcus; D015996:Survival Rate
Acute; Bacterial; Cardiac surgery; Infective endocarditis; Subacute; Valvular heart disease