ABSTRACT
The first reported surgical cure of infective endocarditis (IE) was the repair of a ventricular septal defect and removal of a tricuspid vegetation, which was infected with Candida albicans, by Kay et al. in 1960 (1). In 1965, Wallace et al. (2) removed an aortic valve that was persistently infected with Serratia marcescens. Despite treatment with colistin and kanamycin, the patient remained febrile, his bacteremia continued, and his aortic regurgitation became more severe. After three weeks of medical treatment, the infected valve was removed and replaced with Starr-Edwards prosthesis. The surgical specimen was notable for massive, soft vegetations that involved the perforated left and right coronary cusps. Operative cultures were positive for S. marcescens. The patient recovered without complication and remained free of disease. These surgeons observed sagely: “The results of a combined program of intense antimicrobial therapy and resection of the infected valve produced encouraging results in the correction of the hemodynamic abnormality.” They did add a qualifying statement: “In selected cases, active endocarditis need not be considered a reason for valvular replacement.” This last statement was the first to recognize the major challenge of cardiac surgery performed in the treatment of IE, knowing when an operative procedure should be undertaken. The discussion of the indications for surgery in IE is the major focus of this chapter.
