engleski

Surgical treatment for infective endocarditis in intravenous drug users

To analyse early and long - term outcome of surgical treatment for infective endocarditis (IE) in intravenous drug users (IVDU). From February 1993 to October 2000, 17 IVDU patients were operated for infective endocarditis. There were 4 men and 13 woman whose mean age was 28 years. Indications for operations were acute valvular insufficinency with congestive heart failure, reccurent peripherial and cerebral embolisation (15 patients) or persistent sepsis (10 patients). Aortic valve was infected in 6 (35%), the mitral in 5 (30%) and tricuspid valve in 6 (35%) patients. Diagnosis of acute endocarditis was established by transesophageal echocardiography and blood culture. Staphylococcus aureus was isolated in 11 (62, 5%) patients. 6 patients had aortic valve replacement (AVR), 4 had mitral valve replacement (MVR), 3 had tricuspid valve replacement (TVR), 3 had partial resection and reconstruction of tricuspid valve and one had MV repair. Three patients (17, 6%) died early postoperatively. Statistical analysis identified preoperative congestive heart failure with pulmonary edema (p<0, 05) and renal failure (p<0, 05) as a predictor of early postoperative mortality. Two patients (11%) had recurent IE. One of three patients after TV reconstruction, and one after MV repair had reccurent IE with valvular insufficiency and underwent MVR and TVR. Recurrent IE was connected with paravalvular abscess There was one (6%) late death related to sepsis. 4 of 17 patients were lost for follow up. Surgical treatment for acute infective endocarditis in IVDU is associated with high morbidity and mortality risk in desolated patients with congestive heart failure, pulmonary edema and renal failure, but in others mortality is low and surgical treatment should be undertaken anyhow. Patients after primary mitral valve repair underwent valve replacement lately, but in two patients tricuspidal valve reconstruction was succesful and should be often undertaken.

infective endocarditis; intravenous drugs users; cardiac surgery; acute

DOI: 10.1016/S0967-2109(03)00134-0