Surgery of bacterial aortic insufficiency. Indications and results

Seventy nine patients were operated for aortic regurgitation due to bacterial endocarditis confirmed anatomically at surgery between 1968 and 1984. They were classified into 3 groups according to the stage of endocarditis at the time of operation: progressive endocarditis (21 cases), recent endocarditis (39 cases) and late endocarditis (19 cases). The patients were adults (21 to 70 years) and predominantly male (82 p. 100). Previous valvular disease was found in 38 cases, bicuspid aortic valves were found in 21 cases. Most of the patients operated early (recent progressive endocarditis) had cardiac failure and the surgical indication was nearly always poor haemodynamic tolerance. In addition, this indication was also retained in late forms of the disease in patients usually panci-symptomatic in the presence of signs of increasing left ventricular dysfunction. The aortic lesion was the only pathology in 55 cases and was associated with periannular abscess in 8 cases, septal abscess in 5 cases including one with septal perforation, and mitral endocarditis in 12 cases. Seven patients died during surgery, in low output states in 6 cases (global mortality 8.9 p. 100). The 72 survivors were followed up for an average period of 5 years (4 to 168 months); three patients were lost to follow-up. The actuarial survival rate including the operative mortality was 77 p. 100 at 5 years and 64.6 p. 100 at 10 years. Valve dehiscence was common (52 p. 100); although the perivalvular leak was usually small, in 11 cases it was quite severe and 7 patients had to be reoperated. An excellent functional result was observed in 30 cases, especially in those patients operated early.