Background: Recently developed strategies (valve repair, homograft implantation) may improve clinical outcome in surgical treatment of infective endocarditis. Careful TEE examination may allow to choice the proper surgical treatment in relation to observed anatomic abnormalities. Aim of present investigation was to analyse survival and recurrent endocarditis in patients in whom surgical strategy was planned by TEE examination.  

Methods: 80 consecutive patients with active infective endocarditis (52 males, 28 females, mean age 59.2 years) were investigated. All patients underwent TEE examination within 24 hours from hospital admission. 78 patients underwent surgery, 2 patients died before intervention.  

Results: Aortic was involved more frequently than mitral valve (38 vs. 28 patients). In 10 both valves were involved. Four had tricuspid endocarditis. 24 underwent aortic valve replacement, 12 aortic homograft implant, 2 aortic valve repair, 18 mitral valve replacement and 13 mitral valve repair. Five underwent mitral and aortic replacement. In tricuspid endocarditis valve was repaired in 2 and replaced in 2. Only in one patient surgical exploration induced to change planned strategy. Hospital mortality was 10.2%. 3 discharged patients died at 18 months follow-up. Endocarditis recurred in 4, 2 being S. Aureus prosthetic tricuspid endocarditis in drug addicts. All patients who underwent valve repair or homograft implant were alive and free of recurrence.  Conclusion: Our results suggest that TEE guided surgical treatment of active infective endocarditis is associated with a low mortality and recurrence rate.