General Principles

Infective endocarditis is not a common disease. A French survey in 2002 estimated the incidence of IE at 31 per one million adults [1], and a large European multicenter survey showed that only 159 (3.2%) of 5001 patients with valvular disease had a history of IE [2]. Thus, surgical treatment of IE constitutes a relatively small portion of all cardiac surgery procedures. Yet, during their admission for IE, about a third of all patients required cardiac surgery [3]. Not surprisingly, the absolute number of IE operations is large enough for these procedures to be considered a significant entity in cardiac surgery. Of 1,262 patients undergoing valve surgeries at our institute over a period of 39 months, 51 (4%) were operated on to treat IE.

Surgical procedures for "active" or "acute" IE are technically more demanding than operations for acquired non-infected valvular lesions. The main challenge in acute IE is to address the two coexisting aspects of the disease: (1) the infectious process that requires removal of all infected tissues to prevent recurrence of IE, and (2) the altered valvular anatomy and function that should be corrected or restored. This may require extremely complex and high-risk surgical procedures, although operations in "healed" IE with no residual infection or perivalvular involvement can be handled similar to conventional valve operations.

The decision-making process is key to the final surgical outcome, underlining the critical need for each individual case to be carefully assessed for the infectious process and evaluated for valvular dysfunction in order to decide on when and how to operate.

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