Surgical treatment of infective endocarditis is aimed at:
- Removal of all infected tissue
- Drainage of abscesses (collection of pus)
- Repair of the heart tissue
- Repair or replacement of the affected valve
Surgery for endocarditis is very specialized and demanding. It requires extensive experience and familiarity with different reconstructive methods including the use of homografts (human cadaver valves). Transesophageal echocardiograms (TEE) performed before, during and after surgery help to guide the surgeon and ensure valve function is optimal.
Valve with Infective endocarditis
Aortic Valve: destructive endocarditis caused by staph aureus, with abscess cavity under the pulmonary artery (aortic valve removed)
(RCA - right coronary artery, LCA - left coronary artery, MV - mitral valve)
Aortic Valve: Prosthetic valve endocarditis with circumferential infection and dehiscence of the valve posteriorly (RCA - right coronary artery, LCA - left coronary artery)
Valve Debridement - removal of infected tissue. If the infection has affected only the valve leaflets (cusps), removal of the infected matter will be sufficient. However, if the infection has affected more of the valve or into the heart tissue, then debridement will require a more technically difficult approach
Aortic valve: same valve after debridement, cleaning up
Aortic Valve Endocarditis: After debridement (cleaning) and reconstruction with a homograft
Valve reconstruction - depending on the specific surgical case, the surgeon will repair the valve or replace the valve with a new valve (valve prosthesis). The prosthesis may be biological, mechanical or a homograft. The homograft has proven to be particularly valuable in cases with severe aortic valve endocarditis. In some cases of aortic valve IE, the Ross Procedure may be used.