Cardiac Surgery in Active, Primary Infective Endocarditis

¹ Professor of Surgery, New York Medical College
² Assistant Professor of Medicine, New York Medical College
³ Assistant Professor of Surgery, New York Medical College

Infective endocarditis is primary when intrinsic anatomical parts of the heart are affected, or secondary, when sepsis is on an intracardiac prosthesis. The cases of two patients with primary endocarditis are presented who were in intractable heart failure and were cured by aortic valve replacement. Accounts of 59 other reported cases are reviewed in which valves were replaced or repaired. Currently, active primary endocarditis is life-threatening due to cardiac decompensation, usually from valve leaflet perforation, disintegration or disruption by microbial excrescences. Intractable heart failure is a mandate for prompt surgery, even in the face of demonstrable blood stream infection. Since no portion of the heart may be spared, the surgeon must be prepared to cope with more than one lesion. In this collected series, 70.5 percent of patients were entirely cured; 6.6 percent were benefited but exhibited residual paraprosthetic regurgitation; and 22.9 percent died.