Complex multivalve operations for infective endocarditis

About 45%-50% of patients with infective endocarditis (IE) require surgical intervention, with about 14% of these patients having multivalvular involvement. Those with a more virulent type of infection, or in patients with IE left untreated, can develop intravalvular fibrous body (IFB) involvement, which increases the complexity of repair substantially. Mortality also increases, with five-year survival rates between 25% and 94%. The surgical approach involves debriding all infected tissue, draining any abscesses and repairing over replacing valves if possible, without compromising the integrity of the valve. IFB reconstruction or restoring atrioventricular continuity is sometimes required. Ultimately, multivalvular IE requires a multidisciplinary team for optimal treatment. Surgical intervention should only be pursued after medical treatment has failed or valvular damage has resulted in precarious physiologic derangements in excess of the risk of an emergent operation.