Abstract

GOMEZ ARMANDO GONGA, Joaquín et al. Postoperative complications and mortality observed in patients operated on from infective endocarditis. Rev Cubana Cir [online]. 2013, vol.52, n.1, pp.41-47. ISSN 0034-7493.

Objective: To describe the causes of perioperative morbidity and mortality of patients suffering active infectious endocarditis and to explain how both aspects can be reduced. Methods: A retrospective study of postoperative complications and mortality observed in 139 patients operated on from infectious endocarditis in 16 years. One hundred forty seven surgeries were performed, of which 83 (57.1 %) were elective and 64 (42.9 %) were emergency surgeries. In this group, 24 % had been referred from other medical centers where they had been unsuccessfully treated for 4 weeks. Results: The performed surgeries comprised 15 aortic, mitral and tricuspid valve replacements, 57 (41 %) removals of pacemaker electrodes or of implanted automatic defibrillators in the right ventricle, seven other types of surgeries and 8 reoperations. The most frequent complication was generalized sepsis ((10.07 % p< 0.01), followed by the low heart output and postoperative bleeding. The main causes of death were congestive heart failure in 13 patients (9.3 %, p< 0. 02) and generalized sepsis in 5 patients (3.6 %). The mortality rates presented in this study (16.4 %) were associated to several factors such as functional class, since 12.2 % of patients were classified into the functional class III-IV of the New York Heart Association. The mortality rate was higher in those patients who had been unsuccessfully treated for over 4 years (n= 13, 56.5 %). Low mortality is noticeable (2.1 %) in patients with infectious endocarditis as a result of pacemaker electrodes or cables, or of implanted automatic defibrillators. Conclusions: Early diagnosis, implementation of an intensive antibiotic treatment, early performance of surgery together with rigorous homeostasis results in a stagger reduction of mortality and morbidity in infectious endocarditis surgeries.

Keywords : electrodes; sepsis; endocarditis; extracorporeal circulation; prosthesis; implanted automatic defibrillators.