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Eur J Cardiothorac Surg 2007;32:118-125. doi:10.1016/j.ejcts.2007.02.034
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Surgical treatment of right-sided active infective endocarditis with or without involvement of the left heart: 20-year single center experience

^a Deutsches Herzzentrum Berlin, Department of Cardiothoracic and Vascular Surgery, Berlin, Germany
^b Deutsches Herzzentrum Berlin, Department of Cardiac Pathology, Berlin, Germany

Received 8 November 2006; received in revised form 8 February 2007; accepted 15 February 2007.

^_* Corresponding author. Address: Deutsches Herzzentrum Berlin, Department for Cardiothoracic and Vascular Surgery, Augustenburger Platz 1, 13353 Berlin, Germany. Tel.: +49 30 4593 2219; fax: +49 30 4593 2216. (Email: musci{at}dhzb.de).

Objective: The aim of this paper is to review the 20-year experience of surgical treatment of right-sided infective endocarditis at our institution, and in particular to compare the outcome of isolated right-sided endocarditis to right-sided endocarditis with involvement of the left heart. Methods: Between April 1986 and April 2006, 84 operations had to be performed in 79 patients (49 men, median age 43.5 years). There were 72 (85.7%) cases of native and 12 (14.3%) of prosthetic valve endocarditis. In 57 (67.9%) cases, operation was for isolated right-sided endocarditis (RSE) and in 27 (32.1%) cases for combined right and left-sided endocarditis (RLSE). Follow-up was completed in all 91% of survivors. The median follow-up time at 448 patient years was 3.59 years (range 6 months–19.27 years). Results: There was a highly significant difference between the survival rates of patients operated on due to RSE compared to RLSE: the 30-day, 1-, 5-, 10- and 20-year survival rate after RSE operation was 96.2%, 88.4%, 73.5%, 70.4% and 70.4%, respectively, compared to 72.0%, 67.8%, 50.8%, 35.6% and 35.6% after operation for RLSE (p = 0.0093). Patients with RLSE more often underwent emergency operations (p < 0.001), preoperatively were more often on high-dose catecholamines (p < 0.006) and intraoperatively showed more abscess formation (p < 0.001). Freedom from reoperation at 30 days, 1-, 5-, 10- and 20-year was 97.4%, 95.9%, 92.2%, 88.6% and 88.6%, respectively. Risk factors for early mortality were priority of surgery with an odds ratio (OR) of 5.13, age over 40 years (OR 1.04 and 3.24) and left heart involvement (or 2.54). Conclusions: Our surgical strategy for right-sided infective endocarditis is based on three principles: (1) debridement of the infected area or vegetectomy; (2) valve repair whenever possible, avoiding artificial material; (3) if valve replacement is unavoidable, use of a biological substitute without any artificial material that might become infected. Following these strategies surgery of right-sided infective endocarditis with or without left-side involvement can be performed with good early, mid-term and long-term results. Patients with involvement of the left side showed not only worse preoperative conditions but also a significantly poorer clinical outcome than those with isolated right-sided infective endocarditis.

Abbreviations: IE = infective endocarditis • RSE = right-sided endocarditis • RLSE = right and left-sided endocarditis • IVDU = intravenous drug abuse

Key Words: Right-sided endocarditis • Right- and left-sided endocarditis • Surgery • Tricuspid valve reconstruction • Tricuspid valve replacement

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