[Early surgery in acute endocarditis complicated by cardiac insufficiency; the Moroccan experience]. / Chirurgie précoce dans l'endocardite aiguë compliquée d'insuffisance cardiaque; l'expérience marocaine.

The aim of this review of 20 cases was to identify the surgical indications in heart failure complicating the acute phase of left heart valve endocarditis, to determine the optimal timing of surgery and to evaluate the early and medium term postoperative prognosis. Between January 1985 and May 1990, 20 patients (14 men and 6 women with an average age of 29 +/- 7 years) with native left heart valve endocarditis underwent surgery in the acute phase complicated by heart failure. The were 9 aortic regurgitations and 2 mixed mitral and tricuspid regurgitations. The haemodynamic status of the patients was poor before surgery: 15 NYHA class IV and 5 class III. The average time from the onset of heart failure to surgery was 21 days. The surgical procedure was monovalvular replacement in 14 cases, double valve replacement in 4 cases and 2 isolated mitral valvuloplasties. Two patients died in the first postoperative month of irreducible low output syndrome. One patient was reoperated early for dehiscence of a mechanical valve prosthesis. Late complications included 2 cerebrovascular accidents and one reoperation for degeneration of a bioprosthesis. There were no late fatalities. Seventeen of the 18 survivors are regularly followed up with an average of 80 months follow-up: 12 NYHA class I and 5 class II. The most useful prognostic factor was the preoperative haemodynamic status.(ABSTRACT TRUNCATED AT 250 WORDS)