Cited by 141Infective Endocarditis Diagnosis and ManagementCardiac Valve Diseases and TreatmentsStreptococcal Infections and Treatments

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A case for early surgery in native left-sided endocarditis complicated by heart failure: Results in 203 patients

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Middlemost, Shirley, Wisenbaugh, Thomas, Meyerowitz, Colin, Teeger, Susan, Essop, Rafique, Skoularigis, John, Cronje, Stephanus, Sareli, Pinhas·1991·Journal of the American College of Cardiology

DOI 10.1016/0735-1097(91)90785-8

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Abstract

From January 1982 to December 1988, 203 consecutive patients were selected for early valve replacement (mean 10 days from time of admission) if they had clinical evidence of native valve endocarditis with 1) vegetations on echocardiography, 2) severe valvular lesions, and 3) heart failure. Surgery was performed within 7 days of admission in 56% of patients and was done urgently because of hemodynamic deterioration in 108 (53%). All vegetations were identified by echocardiography and confirmed macroscopically at surgery. One hundred ten patients had isolated aortic valve infection, 50 had isolated mitral valve infection (p less than 0.05 for aortic vs. mitral) and 43 had double-valve infection. Mean aortic cross-clamp time was 57, 38 and 67 min, respectively. Sixty-four patients (32%) had extensive infection involving the anulus or adjacent tissues, or both; such infection more frequently involved the aortic than the mitral valve (p less than 0.05). Thirty-eight patients (35%) with aortic valve infection had abscess formation compared with 1 patient (2%) with mitral valve infection (p less than 0.05). Only eight patients (4%) died in the hospital. There were seven patients (3%) with a periprosthetic leak and five patients (3%) with early prosthetic valve endocarditis. Long-term follow-up, available in 174 hospital survivors (89%), revealed 10 deaths and two new ring leaks at 38 +/- 22 months. In conclusion, among patients with endocarditis who need surgery for heart failure, aortic valve infection is more prevalent than mitral valve infection and is more often associated with extensive infection, including abscess formation.(ABSTRACT TRUNCATED AT 250 WORDS)

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Authors: Middlemost, S., Wisenbaugh, T., Meyerowitz, C., Teeger, S., Essop, R., Skoularigis, J., Cronje, S., & Sareli, P.
Affiliations: Chris Hani Baragwanath Hospital (ZA)
Corresponding author: Middlemost, Shirley
ORCID: Skoularigis, John
Venue: Journal of the American College of Cardiology
Publisher: Elsevier BV
Published: 1991-09
Volume: 18
Issue: 3
Pages: 663-667
ISSN: 0735-1097 (ISSN-L)
DOI: 10.1016/0735-1097(91)90785-8
OpenAlex: W1973206712
Semantic Scholar: 6e7a106bb3a5fc97be317fee64ddfbb1b5d8c2c6
Cited by: 141
References: 47
Citations by year: 2026: 1 · 2025: 1 · 2024: 2 · 2023: 1 · 2022: 2 · 2021: 2 · 2020: 4 · 2019: 4 · 2018: 1 · 2017: 5 · 2016: 3 · 2015: 4 · 2014: 8 · 2012: 4
FWCI: 3.33
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (vor, 7989 d)
Locations: Journal of the American College of Cardiology (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Infective Endocarditis Diagnosis and Management
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Valve Diseases and Treatments
Health Sciences › Medicine › Infectious Diseases › Streptococcal Infections and Treatments
Keywords: infective endocarditis, native valve endocarditis, left-sided endocarditis, heart failure, aortic valve infection, mitral valve infection, periprosthetic leak, prosthetic valve endocarditis, timing of surgery, echocardiographic vegetation
MeSH terms: Adult, Aortic Valve, Endocarditis, Bacterial, Female, Heart Failure, Heart Valve Prosthesis, Humans, Male, Mitral Valve, Postoperative Complications, Retrospective Studies, Risk Factors, Time Factors, Prevalence

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A case for early surgery in native left-sided endocarditis complicated by heart failure: Results in 203 patients

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