[Surgery in acute bacterial endocarditis. Restraints--possibilities]

Abstract

The limitations and possibilities of surgery in acute infective endocarditis depend on the indication, haemodynamic or bacteriological, the site of infection, aortic or mitral, and whether affecting a native or prosthetic valve. The common possibility of conserving the mitral valve in acute endocarditis is an additional therapeutic option. Similarly, the use of aortic homografts has improved the results in aortic endocarditis. Surgical principles have therefore evolved with conservative mitral valve surgery and "biological" aortic valve replacement. Techniques in prosthetic valve endocarditis have not surgery and earlier extra-anatomical procedures to avoid multiple recurrence with use of homografts or Danielson's technique for the aortic orifice. There have been fewer innovations for recurrent endocarditis on mitral valve prostheses. Irrespective of the site or type of endocarditis, the precocity of surgical treatment is an essential prognostic factor.