**5. Indication for surgery in left-sided aortic valve endocarditis**

The reported rate for indication for surgery also varies considerably according to the studies published. Surgery indication is influenced by the characteristics of the centre, which are basically determined by the availability of multidisciplinary teams in patient assessment. The range is very wide, going from very low figures of 9.6% of the patients with endocarditis [12] up to the rates of indication reported by Lung et al. of 73% of the patients attended (with surgery being performed in 46% of the cases) [17]. Analysed by location, aortic endocarditis required surgery in 38.2% of the cases, when aortic valve compromise was 17% lower.

Very few authors study surgery of the aortic valve independently of that of the mitral valve. The majority of the series combine the two in their analyses, considering them the same process, left-sided endocarditis. It should be remembered that there are some differences between the two locations with respect to clinical repercussion, the possibility of generating embolism and the appearance of rhythm disorders.

Bustamante Munguira et al., analysing the Spanish series during the time period 1997–2014, found that the percentage of patients requiring surgery increased over the course of the study, reaching 15.7% of the patients [9]. These figures are much lower than those of the European registry, in which the Euro Heart Survey reported a rate of 58.7% [29]. Once again, the most logical explanation for this finding lies in the establishment of protocols for and in the treatment of endocarditis with the attention of these patients being given by units of reference.

There are intermediate ranges between these figures. One example is the study by Murdoch et al. (with 2781 patients attended in 58 centres in 25 countries), in which 48.2% of the patients underwent surgery [19]. In this study, important differences based on the type of centre were also observed in the percentage of patients that received an indication for surgery, with ranges of 63.4–37.1% (*P* < 0.001). In the series reported by Olmos et al., 23% of the patients required surgery [10]; the percentage was greater in the case of the centres with cardiac surgery (35.5%). A limitation of this study was that it did not analyse the percentage of aortic patients compared with other patients having problems in different locations.

In the study published by Moreira et al. (analysing 233 patients for 8 years), 57% of the patients received the indication for surgery, and the patients were operated in 36.9% of the cases. In that study, the frequency of indication for surgical treatment was analysed according to location. It was found that operations were performed in 64% of the cases of aortic endocarditis, while the percentage was only 31% in the cases of mitral endocarditis [21].

#### **6. Conclusions**

Infective endocarditis has increased its frequency of appearance as a consequence of ageing of the population and of the number of invasive procedures giving rise to the appearance of the condition called health care-associated endocarditis. Left-sided cavities are compromised far more frequently than right-sided ones. However, there is no clear difference between the percentage of aortic and mitral valve involvement. Indications for surgery have gradually increased, but the result considered in terms of morbidity-mortality has not improved despite advances in techniques and postoperative care. It is hard to find studies in which aortic valve compromise is analysed individually, because most studies focus on studying leftcavity endocarditis and consequently produce a global evaluation.

**71**

**Author details**

Valladolid, Spain

Spain

Juan Bustamante-Munguira1

Angels Figuerola-Tejerina3

Princesa, Madrid, Spain

provided the original work is properly cited.

*Infective Endocarditis in Aortic Valve Disease DOI: http://dx.doi.org/10.5772/intechopen.83599*

© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

\*, Eva María Aguilar Blanco2

1 Department of Cardiac Surgery, Hospital Clinico Universitario de Valladolid,

2 Department of Cardiac Surgery, Hospital Universitario 12 de Octubre, Madrid,

3 Department of Prevention and Control of Infection, Hospital Universitario de La

\*Address all correspondence to: jbustamantemunguira@gmail.com

and

### **Conflict of interest**

None declared.

*Infective Endocarditis in Aortic Valve Disease DOI: http://dx.doi.org/10.5772/intechopen.83599*

*Aortic Stenosis - Current Perspectives*

cases of mitral endocarditis [21].

**6. Conclusions**

**Conflict of interest**

None declared.

disorders.

Very few authors study surgery of the aortic valve independently of that of the mitral valve. The majority of the series combine the two in their analyses, considering them the same process, left-sided endocarditis. It should be remembered that there are some differences between the two locations with respect to clinical repercussion, the possibility of generating embolism and the appearance of rhythm

Bustamante Munguira et al., analysing the Spanish series during the time period 1997–2014, found that the percentage of patients requiring surgery increased over the course of the study, reaching 15.7% of the patients [9]. These figures are much lower than those of the European registry, in which the Euro Heart Survey reported a rate of 58.7% [29]. Once again, the most logical explanation for this finding lies in the establishment of protocols for and in the treatment of endocarditis with the

There are intermediate ranges between these figures. One example is the study by Murdoch et al. (with 2781 patients attended in 58 centres in 25 countries), in which 48.2% of the patients underwent surgery [19]. In this study, important differences based on the type of centre were also observed in the percentage of patients that received an indication for surgery, with ranges of 63.4–37.1% (*P* < 0.001). In the series reported by Olmos et al., 23% of the patients required surgery [10]; the percentage was greater in the case of the centres with cardiac surgery (35.5%). A limitation of this study was that it did not analyse the percentage of aortic patients

In the study published by Moreira et al. (analysing 233 patients for 8 years), 57% of the patients received the indication for surgery, and the patients were operated in 36.9% of the cases. In that study, the frequency of indication for surgical treatment was analysed according to location. It was found that operations were performed in 64% of the cases of aortic endocarditis, while the percentage was only 31% in the

Infective endocarditis has increased its frequency of appearance as a consequence of ageing of the population and of the number of invasive procedures giving rise to the appearance of the condition called health care-associated endocarditis. Left-sided cavities are compromised far more frequently than right-sided ones. However, there is no clear difference between the percentage of aortic and mitral valve involvement. Indications for surgery have gradually increased, but the result considered in terms of morbidity-mortality has not improved despite advances in techniques and postoperative care. It is hard to find studies in which aortic valve compromise is analysed individually, because most studies focus on studying left-

attention of these patients being given by units of reference.

compared with other patients having problems in different locations.

cavity endocarditis and consequently produce a global evaluation.

**70**
