Infective Endocarditis Surgery

Overview

What is infective endocarditis?

This condition occurs when fungus or bacteria enter your bloodstream and attack heart valve tissue, usually after invasive procedures like dental work or endoscopy. Normal heart valve tissue is naturally resistant to infection. But diseased valves have defects that make it easier for infections to occur.

How can infective endocarditis affect my health?

Infective endocarditis can be due to many types of fungus or bacteria. Without treatment, these organisms multiply and form colonies (mass-like lesions on your heart valves called vegetations).

Vegetations produce enzymes that destroy healthy heart valve tissue, causing valve dysfunction like a leaky valve. This raises your risk of developing heart failure. If a clump breaks off (embolus) from a vegetation, it can travel through your bloodstream and block blood vessels. This can lead to life-threatening complications, like stroke and pulmonary embolism or interruption of blood flow (ischemia) to an abdominal organ or extremity.

How is infective endocarditis treated?

Treatment depends on the type of fungus or bacteria causing the infection and its severity. When caught in earlier stages, antibiotics can be effective. When there are vegetations, damage to the heart valve or an infected prosthetic valve, surgery is often necessary.

How can infective endocarditis surgery help me?

Surgery helps by:

  • Controlling infection.
  • Preventing or treating complications due to heart valve damage or emboli.
  • Replacing or reconstructing tissue affected by heart valve damage.

How soon will I need surgery?

The timing of your procedure depends on how sick you are. In up to 30% of patients, it’s best to perform surgery within days of diagnosis. This is especially true in patients with replacement valves that become infected.

Other valve-related issues that may require urgent surgery include:

  • Abscesses or aneurysms around your aortic valve.
  • Certain fungal infections with extensive valve damage.
  • Heart failure due to valve issues from infective endocarditis.
  • Large vegetations that are likely to break loose from the valve.
  • Mitral valve chordae rupture, tears in chord-like structures that connect muscles to the tips of your mitral valve flaps (leaflets).
  • Mitral valve stenosis.
  • Valvular regurgitation or leaky valve, which occurs when heart valves don't fully close.

Additional considerations for urgent surgery include complications like:

When is it best to delay surgery?

Healthcare providers may delay surgery in people experiencing neurological complications of infective endocarditis. These include ischemic stroke and intracranial hemorrhage.

The other reason to delay surgery is when the infection is not severe and the complication risk isn’t high. This enables people to take the entire course of antibiotics and go into surgery infection-free. It also enables surgeons to plan the most appropriate procedure for your needs. Healthcare providers use this approach in 20% to 40 % of cases.

Is there a reason a person with infective endocarditis should not have surgery?

A small number of individuals might not be healthy enough for surgery. These include:

  • People with other chronic medical issues that may complicate recovery.
  • Older adults who may be too frail to undergo major surgery.
  • People whose immune systems aren’t healthy.

How will I know if surgery is right for me?

Healthcare providers follow established guidelines for the management of endocarditis. Additionally, healthcare providers use various assessments to determine whether you need surgery. They also help surgeons plan your procedure and determine whether it was successful.

Assessments include:

  • Blood serology tests to determine the type of bacteria or fungus causing infective endocarditis.
  • Physical and medical history to determine the risk of complications.
  • Transesophageal echocardiogram (TEE) and transthoracic echocardiogram (TTE) to locate vegetations and assess heart valve damage.
  • Computed tomography (CT) scans to look for complications of endocarditis.

Procedure Details

What happens during surgery?

The appropriate procedure for your needs depends on the type and severity of heart valve damage. Surgery may include:

  • Debridement to remove infected tissue.
  • Valve repair like mitral chordae repair, reattaching chord-like structures that connect muscles to valve flaps.
  • Valve reconstruction to repair a diseased heart valve, such as using pericardial tissue (pericardium is the sac around the heart) to reconstruct a damaged tricuspid valve.
  • In some cases of severely damaged heart valve, it’s necessary to replace the valve with an artificial one. In case of an abscess around your aortic valve, part of your aorta might need to be replaced.

Risks / Benefits

What are the results of endocarditis surgery?

Once your healthcare provider determines that you need surgery for infective endocarditis, there’s no alternative. The results of the procedure include:

  • Increased chances of survival.
  • Long-term symptom relief.
  • Lower risk of recurring infective endocarditis.
  • Preserved heart functioning, which can help you avoid heart failure.

What are the risks of infective endocarditis surgery?

Potential risks include:

  • Bleeding.
  • Arrhythmia.
  • Blood clots.
  • Stroke or brain bleed
  • Infection in the new heart valve.

Recovery and Outlook

What happens after infective endocarditis surgery?

You can expect to stay in the intensive care unit for the first few days of your recovery, then you go to the regular hospital floor. Providers will continuously monitor your heart in the early stages to check for signs of complications. You may need to stay on antibiotics (oral or intravenous) for several weeks after surgery to eradicate any remaining infection. Once you get home, you’ll need to take it easy. It’s natural to feel tired and sore during this time. Recovery may take longer if you were severely ill before your procedure.

What is the prognosis for people undergoing infective endocarditis surgery?

Having surgery doesn't guarantee a successful recovery. In some cases, vegetations come back after treatment. Some patients continue having health issues due to complications.

The prognosis is better for people who undergo surgery before valve tissue damage and other complications occur. Prognosis is not as good for people who end up with heart failure.

When to Call the Doctor

When should I call my healthcare provider after infective endocarditis surgery?

After infective endocarditis surgery, contact your healthcare provider if you have:

  • Chest fullness or pain, which could be a sign of pericardial effusion.
  • Oozing or abnormal bleeding from the incision site.
  • Redness, warmth or swelling near the incision.
  • Severe bruising.
  • Signs of infection, which include fever or chills.
  • Difficulty breathing or the feeling that your heart is racing or pounding (palpitations).

A note from Cleveland Clinic

Infective endocarditis surgery is for people with difficult-to-treat heart valve infections. A variety of techniques may be necessary, including heart valve repair or replacement. Seeing a surgeon who’s experienced in infective endocarditis surgery gives you the best chances of achieving good results.

Last reviewed by a Cleveland Clinic medical professional on 04/11/2022.

References

  • National Organization for Rare Disorders (NORD). Infective Endocarditis. (https://rarediseases.org/rare-diseases/endocarditis-infective/) Accessed 4/11/2022.
  • Pettersson GB, Hussain ST. Current AATS guidelines on surgical treatment of infective endocarditis. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6892713/) Ann Cardiothorac Surg. 2019;8(6):630-644. Accessed 4/11/2022.
  • Prendergast BD, Tornos P. Surgery for Infective Endocarditis: Who and When? (https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.108.773598) 2010;121:1141–1152. Accessed 4/11/2022.

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