Cardiac Indications for Surgery

The usual indication for surgery is congestive cardiac failure associated with acute valvular dysfunction. This is usually caused by valve dehiscence or perforation and is most apparent in the aortic valve. Acute valve failure carries a high mortality, 60-90% at 6 months. Surgery in this situation dramatically improves survival reducing mortality to 20-40% for native valve disease and 35-55% for prosthetic valve disease [5]. Surgery may also be required to relieve stenosis as a result of vegetation.

Surgery should also be considered for perivalvular infections and abscesses (see image of peri-valvular abscess (aortic valve has been removed), below), uncontrolled infection, removal of large vegetation like in fungal infection, and for Staph aureus associated prosthetic valve disease. Peri-valvular disease should be suspected in patients with persistent and unexplained fever despite appropriate therapy. It complicates 45-50 % of prosthetic valve infections, but also occurs in 10-15% of native valve infections. Surgery is particularly beneficial if medical therapy is not successful, where there is local spread or valve dehiscence.

Staph. aureus endocarditis, particularly in prosthetic valve disease derives significant benefit from surgical debridement. Mortality is reduced from 70% for medical management to nearly 25% with appropriate surgery.

Learning bite

Expeditious surgery decreases mortality in prosthetic valve disease and acute valvular failure.