Circulation, Vol 58, 589-597, Copyright © 1978 by American Heart Association
JV Richardson, RB Karp, JW Kirklin and WE Dismukes
The results of surgical and non-surgical treatment of active infective
endocarditis in 182 patients over a 10-year period were analyzed. Heart
failure, annular and myocardial abscesses, heart block, and coronary
embolism, seen most frequently with staphylococcal and fungal endocarditis,
were the primary causes of death in both native valve endocarditis (NVE)
and prosthetic valve endocarditis (PVE). In NVE, surgery significantly
improved the survival in patients with moderate or severe heart failure (P
less than 0.05) and in all patients with staphylococcal endocarditis (P
less than 0.03). In PVE, surgery significantly influenced survival in
patients with moderate or severe heart failure (P less than 0.05) and in
the entire group with late PVE (P less than 0.01). Early surgery is
recommended for patients with native valve endocarditis and moderate or
severe heart failure; those patients with staphylococcal NVE, regardless of
hemodynamic state, should undergo early valve replacement. Early surgery is
recommended for PVE patients with moderate or severe heart failure. We also
recommend early valve replacement for early and late staphylococcal PVE.
ARTICLES
Treatment of infective endocarditis: a 10-year comparative analysis
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