A Contemporary Strategy for the Surgical Treatment of Destructive Forms of Infective Endocarditis

Introduction. Despite recent achievements in medicine, many issues in the diagnosis and treatment of infective endocarditis (IE) remain outstanding. This is mainly due both to an increase in the incidence and changes in the clinical picture of this nosology. An important factor here is the continuing presence of existing principles governing the approach to the surgical treatment of infective endocarditis, including prosthetic endocarditis.

Objective: to evaluate the effectiveness of an integrated approach to the treatment of infective endocarditis in patients with valvular heart disease on the basis of 37 years of experience.

Materials and methods. An analysis of the surgical treatment of 1097 patients with infectious lesions of the valvular heart apparatus was carried out. The mean age of the sample was 35.1 ± 9.7 years (from 4 months to 68 years); 67.2 % were men, while women made up 32.8 %. Additionally, 122 patients had infectious lesions affecting 2 or more valves. In 109 cases, valvular prosthetic endocarditis was diagnosed; in 37 patients, IE was detected against the background of congenital heart defects. 99 patients had perianular abscesses. Of all surgical interventions carried out, 18 were repeated, including those with non-valvular congenital heart defects.

Results and discussion. Overall hospital mortality was 4.3 % (47 patients). In patients with IE complicated by a congenital heart defect (CHD), mortality was 14.7 %; with endocarditis of mechanical heart valves — 13.2 %; in drug-dependent patients — 4.5 %; with infectious destruction of native heart valves — 2.8 %; in patients with a background of electrodeinduced endocarditis, no deaths during hospitalisation were observed.

Conclusions. The effectiveness of surgical intervention of infective endocarditis can reach 85.4 %. When supplemented with pathogenetic and etiotropic therapy, surgical correction of affected heart structures contributes to the rapid and reliable sanitation of all infection foci, as well as to a reduction in multiple organ failure. Timely surgery significantly reduces the degree of heart failure and improves the NYHA functional class. In the long term, reconstructive interventions contribute to a better heart recovery than prosthetic operations. It should be noted that the proposed treatment approach for this group of patients creates conditions for adequate labour and social rehabilitation in a distant postoperative period. 

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