Valve replacement in active infective endocarditis.

To assess the role of emergency valve replacement in patients with active infective endocarditis (IE), we reviewed 30 patients who underwent valve replacement within 3 months of the diagnosis of IE. Eighteen patients fulfilling the criteria for active IE underwent emergency surgery. The aortic valve was involved in all cases and was previously thought to be normal in 12 (67%). There were 5 early deaths (27,7%), 4 due to circulatory failure and 1 due to rupture of a mycotic cerebral aneurysm. Prosthetic valve dehiscence (paravalvular leak) developed in only 1 patient, and prosthetic valve endocarditis did not occur. The results confirm the place of early valve replacement in otherwise moribund patients with IE. We recommend immediate valve replacement for active IE in the presence of: (i) progressive haemodynamic deterioration; (ii) failure to obtain early control of infection; (iii) significant emboli; and (iv) conduction disturbances.