Surgical Treatment of Infective Endocarditis

Na, Chan Young

Abstract

Infective endocarditis includes conditions in which the structure of the heart, most frequently the valves, harbors an infective process that leads to valvular dysfunction, localized or generalized sepsis, or sites for embolism. Predisposing factors for infective endocarditis are cardiac abnormalities that disrupt the endocardium by means of a jet injury as well as the presence of blood-born microorganisms that colonize these abnormal surfaces. Clinical features are present when defined in accordance with the New York Heart Association criteria, positive blood culture associated with either new or changing murmur or with embolic phenomena, or new or changing murmur in a patient with a congenital cardiac anomaly or with prior valve damage, associated with either embolic phenomena or sustained fever, anemia, and splenomegaly. Goals of operative therapy are to 1) remove infected tissue and drain abscess, 2) restore or reconstruct atrioventricular or ventriculoarterial continuity and 3) reverse the hemodynamic abnormality. The prognosis of infective endocarditis depends largely on when the disease is diagnosed and how promptly it is treated. The results of surgery for infective endocarditis have improved significantly during the past three decades. In a recent series of surgically treated patients, the operative mortality for native valve endocarditis was under 10% and for prosthetic valve endocarditis was 20% to 30%. This article reviewed the recent tends of surgical techniques and results of infective endocarditis and Sejong General Hospital experience in the past 10 years.