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Kildahl HA, Brenne EL, Dalen H, Wahba A. Systemic embolization in infective endocarditis. Indian J Thorac Cardiovasc Surg 2024; 40:40-46. [PMID: 38827555 PMCID: PMC11139814 DOI: 10.1007/s12055-023-01616-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/13/2023] [Accepted: 09/13/2023] [Indexed: 06/04/2024] Open
Abstract
Embolism is a common complication in infective endocarditis which may lead to serious complications, such as stroke, intestinal ischemia, and peripheral embolization. A comprehensive literature search was performed and the registry at our centre, including 390 cases of infective endocarditis, diagnosed between 2010 and 2020, was investigated. Large registries show that 20-40% of patients with infective endocarditis (IE) are affected by embolism. In many instances, embolism is present already at the time of diagnosis. The rate of embolism during the hospital stay in our data was 11%. However, only 2% developed clinical embolism during or following surgery. According to recent guidelines, previous embolism, and the presence of vegetations > 10 mm present an indication for surgical treatment. Routine imaging revealed non-symptomatic cerebral embolism in 8.5% of surgical patients. However, it is not clear whether detection of non-symptomatic embolism and consecutive surgical treatment improves the prognosis of infective endocarditis.
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Affiliation(s)
- Henrik Agerup Kildahl
- Department of Cardiothoracic Surgery, St Olavs Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Box 8905, 7491 Trondheim, Norway
| | | | - Håvard Dalen
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Box 8905, 7491 Trondheim, Norway
- Department of Cardiology, St Olavs Hospital, Trondheim, Norway
| | - Alexander Wahba
- Department of Cardiothoracic Surgery, St Olavs Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Box 8905, 7491 Trondheim, Norway
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2
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Delgado V, Ajmone Marsan N, de Waha S, Bonaros N, Brida M, Burri H, Caselli S, Doenst T, Ederhy S, Erba PA, Foldager D, Fosbøl EL, Kovac J, Mestres CA, Miller OI, Miro JM, Pazdernik M, Pizzi MN, Quintana E, Rasmussen TB, Ristić AD, Rodés-Cabau J, Sionis A, Zühlke LJ, Borger MA. 2023 ESC Guidelines for the management of endocarditis. Eur Heart J 2023; 44:3948-4042. [PMID: 37622656 DOI: 10.1093/eurheartj/ehad193] [Citation(s) in RCA: 143] [Impact Index Per Article: 143.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
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3
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Nappi F, Schoell T, Spadaccio C, Acar C, da Costa FDA. A Literature Review on the Use of Aortic Allografts in Modern Cardiac Surgery for the Treatment of Infective Endocarditis: Is There Clear Evidence or Is It Merely a Perception? Life (Basel) 2023; 13:1980. [PMID: 37895362 PMCID: PMC10608498 DOI: 10.3390/life13101980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/18/2023] [Accepted: 09/25/2023] [Indexed: 10/29/2023] Open
Abstract
Infective valve endocarditis is caused by different pathogens and 60% of those involve the aortic valve with valve failure. Although S. aureus is recognized as the most frequently isolated causative bacterium associated with IE in high-income countries, Gram-positive cocci nevertheless play a crucial role in promoting infection in relation to their adhesive matrix molecules. The presence of pili on the surface of Gram-positive bacteria such as in different strains of Enterococcus faecalis and Streptococcus spp., grants these causative pathogens a great offensive capacity due to the formation of biofilms and resistance to antibiotics. The indications and timing of surgery in endocarditis are debated as well as the choice of the ideal valve substitute to replace the diseased valve(s) when repair is not possible. We reviewed the literature and elaborated a systematic approach to endocarditis management based on clinical, microbiological, and anatomopathological variables known to affect postoperative outcomes with the aim to stratify the patients and orient decision making. From this review emerges significant findings on the risk of infection in the allograft used in patients with endocarditis and no endocarditis etiology suggesting that the use of allografts has proved safety and effectiveness in patients with both pathologies.
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Affiliation(s)
- Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord, 93200 Saint-Denis, France;
| | - Thibaut Schoell
- Department of Cardiac Surgery, Centre Cardiologique du Nord, 93200 Saint-Denis, France;
| | - Cristiano Spadaccio
- Cardiothoracic Surgery, Lancashire Cardiac Center, Blackpool Victoria Hospital, Blackpool FY3 8NP, UK;
| | - Christophe Acar
- Department of Cardiothoracic Surgery, Hôpital Pitié-Salpêtrière, Boulevard de Hôpital 47-83, 75013 Paris, France;
| | - Francisco Diniz Affonso da Costa
- Department of Cardiovascular Surgery, Instituto de Neurologia e Cardiologia de Curitiba—INC Cardio, Curitiba 81210-310, Parana, Brazil;
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4
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Garzón-Furné AI, Ferreiro-Marzal A, Rodríguez-Serrano F, Esteban-Molina M, García-Orta R, Moreno-Escobar E, García-Delgado M, Sevilla-Martínez M, Gómez-Luque JM, Ocete-Hita E, Rodríguez-Vázquez del Rey MDM, Nuila-Durán LM, Garrido JM. Reparación valvular en la endocarditis mitral. CIRUGIA CARDIOVASCULAR 2023. [DOI: 10.1016/j.circv.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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5
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Should more patients be offered repair for mitral valve endocarditis? a single-centre 15-year experience. J Cardiothorac Surg 2022; 17:243. [PMID: 36180915 PMCID: PMC9523968 DOI: 10.1186/s13019-022-01997-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 09/18/2022] [Indexed: 12/05/2022] Open
Abstract
Objective To describe the long-term outcomes of mitral valve repair (MVr) versus mitral valve replacement (MVR) in patients with native valve infective endocarditis (IE) at a centre with high-repair rates. Methods We conducted a retrospective single-centre cohort study. From 2005 to 2021, 183 patients with active or healed native valve IE were included. The primary outcome was long-term mortality. Patient status was last confirmed 31 March 2021. Secondary outcomes were post-operative MR, MV reoperation, length of post-operative intensive care stay and total hospital stay. Results 85 patients (46.4%) underwent MVr and 98 (53.6%) underwent MVR. Follow-up was 98.9% complete. Mean follow-up time was 5.3 years with 17% of patients reaching a follow-up time of over 10 years. There were 47 deaths (25.7%) within the follow-up period. MVR patients were more likely to have higher logistic EuroSCORE, active IE and were less likely to have elective surgery. In multivariate Cox proportional hazards analysis, there was no significant difference in long-term mortality between MVr and MVR groups (hazard ratio 1.09, 95% confidence interval [0.59–2.00]). In Kaplan–Meier analysis, MVR patients had a higher all-cause mortality although there was no significant difference at the endpoint. Propensity score matching analysis showed a significantly higher mortality in the replacement group instead (p = 0.002), Subgroup analysis revealed there remained no significant difference in mortality even in patients with active IE (P-interaction = 0.859) or non-elective surgery (P-interaction = 0.122). MV reoperation (odds ratio 1.00 [0.24–4.12]), post-operative intensive care stay (p = 0.9650) and total hospital stay (p = 0.9144) were comparable. Conclusions Our data demonstrates repair was at least non-inferior to replacement in IE, supporting more aggressive use of repair. There is no reason the general principle of why repair is superior to replacement should not hold in IE, with enough operator expertise. Other experienced units should be encouraged to increase repair rates as feasible in line with current guidelines. Supplementary Information The online version contains supplementary material available at 10.1186/s13019-022-01997-2.
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6
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Di Mauro M, Bonalumi G, Calafiore AM, Lorusso R. Valve endocarditis, to repair or not to repair, is that really the question? J Card Surg 2022; 37:1016-1018. [PMID: 35023588 DOI: 10.1111/jocs.16232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 12/31/2021] [Indexed: 11/30/2022]
Abstract
The meta-analysis by He et al. has the worth to cover, as much as possible, a gap of scientific evidence were conducting a randomized trial appears very complex for ethical and logistical reasons. The authors concluded that mitral valve repair (MVP) provides better-pooled results, both early and late, with respect to mitral valve replacement. However, the superiority of MVP is driven by some single large cohort studies where surgeons had wide experience in the field of MVP for infective endocarditis. This finding is also confirmed by other studies. But if mitral repair produces such a better short- and long-term survival than replacement, why are there no clear indications from consensus and guidelines pushing surgeons toward the pursuit of a reconstructive procedure at almost any cost? We wonder to repair or not to repair, is that really the question? The AATS consensus suggests repairing "whenever possible" but without providing more specific indications. If the two primary goals of surgery are total removal of infected tissues and reconstruction of cardiac morphology, including repair or replacement of the affected valve(s), probably MVP should be performed in case of less extensive tissue detriment by the infection. In more wide valve involvement, MVP may be the choice but only in very expert hands and in Centers with a very large volumes of valve repairing. This decision cannot, therefore, be the result of the choice of an individual but must derive from a careful multidisciplinary discussion to be held in an EndoTeam.
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Affiliation(s)
- Michele Di Mauro
- Cardio-Thoracic Surgery Unit, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
| | - Giorgia Bonalumi
- Department of Cardiac Surgery, Centro Cardiologico Monzino, Milan, Italy
| | | | - Roberto Lorusso
- Cardio-Thoracic Surgery Unit, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
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7
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Defauw RJ, Tomšič A, van Brakel TJ, Marsan NA, Klautz RJM, Palmen M. A structured approach to native mitral valve infective endocarditis: Is repair better than replacement? Eur J Cardiothorac Surg 2021; 58:544-550. [PMID: 32333009 PMCID: PMC7453034 DOI: 10.1093/ejcts/ezaa079] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 02/04/2020] [Accepted: 02/12/2020] [Indexed: 12/12/2022] Open
Affiliation(s)
- Rufin J Defauw
- Department of Cardio-Thoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Anton Tomšič
- Department of Cardio-Thoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Thomas J van Brakel
- Department of Cardio-Thoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Robert J M Klautz
- Department of Cardio-Thoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Meindert Palmen
- Department of Cardio-Thoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
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8
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Abstract
The 2 primary objectives of surgery in mitral valve infective endocarditis (IE) are total removal of the infected tissue and reconstruction of cardiac morphology, including repair or replacement of the affected valve. Single-institution series have suggested the feasibility and effectiveness of mitral valve repair (MVrep) over replacement in mitral IE in terms of in-hospital mortality and long-term event-free survival. This article reviews the history, details of the relevant repair techniques, and clinical results of MVrep for mitral IE.
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Affiliation(s)
- Yukikatsu Okada
- Heart Valve Center, Midori Hospital, 1-16 Edayoshi Nishi-ku, Kobe 651-2133, Japan.
| | - Takeo Nakai
- Heart Valve Center, Midori Hospital, 1-16 Edayoshi Nishi-ku, Kobe 651-2133, Japan
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojimaminamimachi Chuo-ku, Kobe 650-0047, Japan
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9
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Brescia AA, Watt TMF, Rosenbloom LM, Williams AM, Bolling SF, Romano MA. Patient and Surgeon Predictors of Mitral and Tricuspid Valve Repair for Infective Endocarditis. Semin Thorac Cardiovasc Surg 2021; 34:67-77. [PMID: 33865973 DOI: 10.1053/j.semtcvs.2021.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 03/11/2021] [Indexed: 11/11/2022]
Abstract
Mitral repair (MVr) is superior to replacement for degenerative disease; however, its benefit is less established for endocarditis. We report outcomes of repair or replacement for mitral/tricuspid endocarditis and identify predictors of MVr. Patients undergoing first-time surgery for mitral (n = 260) or tricuspid (n = 71) endocarditis between 1992 to 2018 were identified. Patients with aortic endocarditis were excluded. Primary outcome was all-cause mortality and secondary outcome was MVr. Patients were stratified into active and treated endocarditis separately for mitral and tricuspid groups. Predictors of MVr were assessed through multivariable logistic regression and adjusted likelihood of MVr through marginal effects estimates. A mitral specialist was defined by performing ≥25 annual degenerative MVr. Among 331 patients, 70% (181/260) of those with mitral valve endocarditis and 52% (37/71) of those with tricuspid endocarditis underwent repair. The MVr group compared with replacement had a higher proportion of elective acuity and less diabetes, hypertension, active endocarditis, cardiogenic shock, and dialysis. Estimated 5-year survival did not differ between repair versus replacement for active mitral (68 ± 14% vs 60 ± 14%, P = 0.34) or tricuspid endocarditis (60 ± 17% vs 61 ± 19%, P = 0.67), but was superior after repair for treated mitral endocarditis (86 ± 7% vs 51 ± 24%, P = 0.014). Independent predictors of mortality included dialysis for active and treated mitral endocarditis, and mitral replacement (vs MVr) for treated mitral endocarditis. The likelihood of MVr was 82 ± 5% for mitral specialists and 47 ± 9% for non-specialists (P < 0.001). MVr for endocarditis should be pursued, if feasible. Importantly, achieving MVr was driven not only by patient factors, but also surgeon experience.
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Affiliation(s)
| | - Tessa M F Watt
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Liza M Rosenbloom
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Aaron M Williams
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Steven F Bolling
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Matthew A Romano
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan.
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10
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Harky A, Botezatu B, Kakar S, Ren M, Shirke MM, Pullan M. Mitral valve diseases: Pathophysiology and interventions. Prog Cardiovasc Dis 2021; 67:98-104. [PMID: 33812859 DOI: 10.1016/j.pcad.2021.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 03/28/2021] [Indexed: 12/17/2022]
Abstract
Valvular heart disease is common and increasingly prevalent among the elderly. The end result of valvular pathologies is cardiac failure and can lead to sudden death; thus, diagnosis and interventions are very important in the early stages of these diseases. The usual treatment methods of mitral regurgitation include percutaneous mitral valve repair, mitral valve replacement and minimally invasive surgery, whereas the treatment methods of mitral stenosis include percutaneous transluminal mitral commissurotomy and mitral commissurotomy as well as open surgical repair. Nonetheless, ongoing clinical trials are a clear indicator that the management of valve diseases is ever evolving. The focus of this paper is on the various pathologies of the mitral valve, their etiology and clinical management, offering a comprehensive view of mitral valve diseases.
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Affiliation(s)
- Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest, Liverpool, UK; Department of Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK; Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK.
| | - Bianca Botezatu
- Department of Medicine, Queen's University Belfast, School of Medicine, Belfast, UK
| | - Sahil Kakar
- Department of Medicine, Queen's University Belfast, School of Medicine, Belfast, UK
| | - Moliu Ren
- Department of Medicine, Queen's University Belfast, School of Medicine, Belfast, UK
| | - Manasi Mahesh Shirke
- Department of Medicine, Queen's University Belfast, School of Medicine, Belfast, UK
| | - Mark Pullan
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest, Liverpool, UK
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11
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Outcomes of surgical treatment for active infective endocarditis of mitral valve compared using complexity scoring. Gen Thorac Cardiovasc Surg 2020; 69:434-443. [PMID: 32749599 DOI: 10.1007/s11748-020-01456-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 07/28/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate our surgical treatment outcomes of active infective endocarditis (IE) of mitral valve in relation to the patients' complexity scores. METHODS We reviewed 51 patients who underwent surgical treatment for active IE on the mitral valve, in our hospital between September 2002 and November 2016. We adapted a complexity scoring scale to describe the range of parts suffering vegetation and damage, assigning the following weighting: weight 1 for each posterior segment; weight 2 for each anterior segment, commissural segment, left atrium, or left ventricle; weight 3 if the annulus was involved or if pathology extended to a prior mitral operation site. A total of 51 patients were identified and categorized by complexity score into two groups: 1-2: Simple (n = 19); ≥ 3: Complex (n = 32). RESULTS MV repair was achieved in 18 patients (95%) in the Simple group and 26 patients (81%) in the Complex group. In the Complex there were 2 in-hospital deaths (6%). There were none in the Simple. The 5-year survival rates were 100% in the Simple and 79.6% in the Complex (P < 0.05). The 5-year rates of freedom from mitral regurgitation were 77.8% in the Simple and 91.5% in the Complex (P = 0.63). The 5-year rates of freedom from recurrence of IE were 93.3% in the Simple and 92.2% in the Complex (P = 0.76). CONCLUSIONS We found consistent outcomes in terms of recurrent mitral regurgitation and recurrence of IE, regardless of lesion complexity.
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12
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Abstract
The annual incidence of infective endocarditis (IE) is estimated to be between 15 and 80 cases per million persons in population-based studies. The incidence of IE is markedly increased in patients with valve prostheses (>4 per 1,000) or with prior IE (>10 per 1,000). The interaction between platelets, microorganisms and diseased valvular endothelium is the cause of vegetations and valvular or perivalvular tissue destruction. Owing to its complexity, the diagnosis of IE is facilitated by the use of the standardized Duke-Li classification, which combines two major criteria (microbiology and imaging) with five minor criteria. However, the sensitivity of the Duke-Li classification is suboptimal, particularly in prosthetic IE, and can be improved by the use of PET or radiolabelled leukocyte scintigraphy. Prolonged antibiotic therapy is mandatory. Indications for surgery during acute IE depend on the presence of haemodynamic, septic and embolic complications. The most urgent indications for surgery are related to heart failure. In the past decade, the prevention of IE has been reoriented, with indications for antibiotic prophylaxis now limited to patients at high risk of IE undergoing dental procedures. Guidelines now emphasize the importance of nonspecific oral and cutaneous hygiene in individual patients and during health-care procedures.
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13
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Long-term Performance of Fresh Autologous Pericardium for Mitral Valve Leaflet Repair. Ann Thorac Surg 2020; 109:36-41. [DOI: 10.1016/j.athoracsur.2019.05.045] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 04/12/2019] [Accepted: 05/13/2019] [Indexed: 12/21/2022]
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14
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De Martino A, Milano AD, Bortolotti U. Use of Pericardium for Cardiac Reconstruction Procedures in Acquired Heart Diseases-A Comprehensive Review. Thorac Cardiovasc Surg 2019; 69:83-91. [PMID: 31604358 DOI: 10.1055/s-0039-1697918] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Reconstruction of cardiac structures has been the goal of many surgeons even before the advent of open-heart procedures with cardiopulmonary bypass. Unsatisfactory results with synthetic materials has switched the attention to biological tissues, among which pericardium, either autologous or of animal origin, has been widely used as patch material. METHODS We have reviewed the literature to assess the effective role of pericardial tissue in the correction of various acquired cardiac lesions. Particularly, special attention was given not only to established techniques but also to detect any peculiar and unusual application of pericardium. RESULTS Autologous pericardium is frequently used as patch material particularly when limited valvular lesions must be corrected, while xenograft pericardium appears particularly useful in patients with endocarditis and extensive destruction of the intracardiac structures by infection and abscesses. Pericardium is an extremely versatile material owing to its pliability and strength; however, it tends to calcify in the long term when in contact with blood, although stability of the repair is maintained in most cases. CONCLUSIONS Pericardium plays an important role in various cardiac and aortic pathologies. Tissues resistant to fibrosis and calcification to be used as patch material are the ideal solution for more successful cardiac reconstruction procedures and will hopefully be provided by the ongoing research.
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Affiliation(s)
| | - Aldo D Milano
- Department of Cardiac Surgery, University of Bari Aldo Moro, Bari, Italy
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15
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Cuerpo GP, Valerio M, Pedraz A, Rodríguez-Abella H, Mestres CA, Obrador EQ, González-Calle A, Rodríguez Álvarez R, García PM, Bouza E. Mitral valve repair in infective endocarditis is not inferior to valve replacement: results from a Spanish nationwide prospective registry. Gen Thorac Cardiovasc Surg 2019; 67:585-593. [PMID: 30666586 DOI: 10.1007/s11748-019-01063-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 01/07/2019] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Infective endocarditis (IE) still carries high morbidity and mortality and frequently requires surgery. The benefit of mitral valve repair (MVr) in the setting of IE is yet to be proven. The goal of this study was to assess the results of MVr in patients with IE after a minimum follow-up of 1 year. METHODS This study is based on a Spanish nationwide prospective registry that included patients operated on for native mitral valve IE. The collaborating Institutions pooled their pre-, peri-, and postoperative data into the database of the GAMES group [Grupo de Apoyo al Manejo de la EndocarditiS (Group for support and management of infective endocarditis)]. RESULTS Data from 27 hospitals were recorded and 3524 cases of active IE identified between 2008 and 2016. There were 1513 cases of mitral IE, of which 898 involved native valves. Of these, 437 patients underwent surgical treatment, and 369 completed the 1-year follow-up. The valve was repaired in 68 cases (18.4%). Preoperative groups were comparable (EuroSCORE MVr 7.7 vs MVR 8.0; p = ns). Mortality in the repair group was inferior to that in the replacement group (16.2% vs 27.2%, p = 0.058). At 1 year, mortality remained higher in the replacement group: 3.7% vs 2.9%. Relapse of the infection was slightly more frequent in the repair group (7.1% vs 3.7%; p = ns), although this did not lead to higher rates of reintervention (MVr/MVR: 2.9% vs 4.9%). CONCLUSION MVr is an attractive option for specific patients with IE and does not seem to negatively impact on relapses.
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Affiliation(s)
- Gregorio P Cuerpo
- Servicio de Cirugía Cardíaca, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
- Department of Cardiac Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - M Valerio
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - A Pedraz
- Servicio de Cirugía Cardíaca, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - H Rodríguez-Abella
- Servicio de Cirugía Cardíaca, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Carlos A Mestres
- Department of Cardiovascular Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Antonio González-Calle
- Servicio de Cirugía Cardiaca, Unidad del Corazón, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Regino Rodríguez Álvarez
- Servicio de Microbiología y Enfermedades Infecciosas, Hospital Universitario de Cruces, Bilbao, Spain
| | - Patricia Muñoz García
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Emilio Bouza
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
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Choudhury TA, Flyer JN, Ushay HM, Ofori-Amanfo G. A Case of Mitral Valve Endocarditis Complicated by Multiple Embolic Phenomena: Leaping from Adult Guidelines to Pediatric Critical Care Decisions. J Pediatr Intensive Care 2018; 8:170-174. [PMID: 31404392 DOI: 10.1055/s-0038-1675583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 10/02/2018] [Indexed: 10/27/2022] Open
Abstract
Early surgical intervention for children with infective endocarditis (IE) and cerebrovascular sequelae has significant risks, resulting in practice variation amongst pediatric cardiologists, intensivists, and cardiothoracic surgeons. The limited pediatric consensus recommendations make decision making for practitioners challenging. The added risk of multiorgan dysfunction syndrome can make these decisions even more difficult. We present the case of a 14-year-old with IE and resultant multiorgan dysfunction syndrome including cerebrovascular complication, successfully treated by primary valve repair within the 1st week of diagnosis.
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Affiliation(s)
- Tarif A Choudhury
- Department of Pediatrics, Division of Pediatric Cardiology and Pediatric Critical Care Medicine, Columbia University Medical Center, Morgan Stanley Children's Hospital of New York, New York, New York, United States
| | - Jonathan N Flyer
- Department of Pediatrics, Division of Pediatric Cardiology, The Robert Larner, M.D. College of Medicine at The University of Vermont, University of Vermont Children's Hospital, Burlington, Vermont, United States
| | - Henry M Ushay
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Albert Einstein College of Medicine, The Children's Hospital at Montefiore, Bronx, New York, United States
| | - George Ofori-Amanfo
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Icahn School of Medicine at Mount Sinai, Kravis Children's Hospital, New York, New York, United States
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Nakamura K, Hashimoto K, Sakamoto Y, Bando K, Yoshitake M, Matsumura Y, Kinouchi K, Abe T. Safe Use of Glutaraldehyde to Repair the Destroyed Valve in Active Infective Mitral Valve Endocarditis. Circ J 2018; 82:2530-2534. [PMID: 30068854 DOI: 10.1253/circj.cj-17-1433] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The aim of this study was to review our experience of mitral valve (MV) repair for acute and active infective endocarditis (AAIE) and to identify the feasibility of a new approach together with the mid-term results. Methods and Results: A retrospective analysis was performed on 35 consecutive AAIE patients surgically treated in the isolated mitral position. Mean follow-up after the surgery was 4.3±3.7 years. 30 of the 35 patients were successfully treated by MV plasty (MVP); however, MV replacement (MVR) was necessary in the remaining 5 patients. Our novel approach included resection of the infective lesion, approximation with direct suture and/or patch repair with bovine or autopericardium after 2-min treatment of it and the defective leaflet edge(s) with 0.625% glutaraldehyde solution, reconstruction with artificial chordae and ring annuloplasty. The success rate of MVP was 85.7%. The longest postoperative follow-up echocardiography showed no mitral regurgitation (MR) in 4, trivial MR in 4, mild MR in 16 and moderate MR in 5 patients in the MVP group. The 5-year survival rate in the MVP group was 89±6%. MVR was required in 1 patient 2 months after MVP because of increasing MR. Recurrence of endocarditis has not been observed in any case. CONCLUSIONS Glutaraldehyde was safely used in a surgical intervention for AAIE in the mitral position with acceptable early and mid-term results.
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Affiliation(s)
- Ken Nakamura
- Department of Cardiac Surgery, The Jikei University School of Medicine
| | | | | | - Ko Bando
- Department of Cardiac Surgery, The Jikei University School of Medicine
| | - Michio Yoshitake
- Department of Cardiac Surgery, The Jikei University School of Medicine
| | - Yoko Matsumura
- Department of Cardiac Surgery, The Jikei University School of Medicine
| | - Katsushi Kinouchi
- Department of Cardiac Surgery, The Jikei University School of Medicine
| | - Takayuki Abe
- Department of Cardiac Surgery, The Jikei University School of Medicine
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18
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Solari S, De Kerchove L, Tamer S, Aphram G, Baert J, Borsellino S, Mastrobuoni S, Navarra E, Noirhomme P, Astarci P, Rubay J, El Khoury G. Active infective mitral valve endocarditis: is a repair-oriented surgery safe and durable?†. Eur J Cardiothorac Surg 2018; 55:256-262. [DOI: 10.1093/ejcts/ezy242] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 06/05/2018] [Indexed: 02/06/2023] Open
Affiliation(s)
- Silvia Solari
- Department of Cardiovascular and Thoracic Surgery, Saint Luc University Clinic, Brussels, Belgium
| | - Laurent De Kerchove
- Department of Cardiovascular and Thoracic Surgery, Saint Luc University Clinic, Brussels, Belgium
| | - Saadallah Tamer
- Department of Cardiovascular and Thoracic Surgery, Saint Luc University Clinic, Brussels, Belgium
| | - Gaby Aphram
- Department of Cardiovascular and Thoracic Surgery, Saint Luc University Clinic, Brussels, Belgium
| | - Jerome Baert
- Department of Cardiovascular and Thoracic Surgery, Saint Luc University Clinic, Brussels, Belgium
| | - Stefano Borsellino
- Department of Cardiovascular and Thoracic Surgery, Saint Luc University Clinic, Brussels, Belgium
| | - Stefano Mastrobuoni
- Department of Cardiovascular and Thoracic Surgery, Saint Luc University Clinic, Brussels, Belgium
| | - Emiliano Navarra
- Department of Cardiovascular and Thoracic Surgery, Saint Luc University Clinic, Brussels, Belgium
| | - Philippe Noirhomme
- Department of Cardiovascular and Thoracic Surgery, Saint Luc University Clinic, Brussels, Belgium
| | - Parla Astarci
- Department of Cardiovascular and Thoracic Surgery, Saint Luc University Clinic, Brussels, Belgium
| | - Jean Rubay
- Department of Cardiovascular and Thoracic Surgery, Saint Luc University Clinic, Brussels, Belgium
| | - Gébrine El Khoury
- Department of Cardiovascular and Thoracic Surgery, Saint Luc University Clinic, Brussels, Belgium
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19
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Lee HA, Cheng YT, Wu VCC, Chou AH, Chu PH, Tsai FC, Chen SW. Nationwide cohort study of mitral valve repair versus replacement for infective endocarditis. J Thorac Cardiovasc Surg 2018; 156:1473-1483.e2. [PMID: 29843917 DOI: 10.1016/j.jtcvs.2018.04.064] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 03/28/2018] [Accepted: 04/12/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The feasibility and long-term outcomes of mitral valve (MV) repair in patients with infective endocarditis (IE) remain unclear. METHODS Using Taiwan's National Health Insurance Research Database, we identified 1999 patients who underwent MV surgery for IE during 2000 to 2013. The patients were more likely to have undergone valve replacement (1575 patients; 78.8%) than valve repair (424 patients; 21.2%). After 1:1 propensity score matching, 352 patients in each group were included for analysis. Perioperative outcomes and late composite end points, comprising all-cause mortality, MV reoperation, any stroke, major bleeding, and readmission for heart failure, were compared. RESULTS Patients who received MV repair had fewer perioperative complications, lower in-hospital mortality rates (6.3% vs 10.8%; P = .031), and lower risks of late mortality (hazard ratio [HR], 0.59; 95% confidence interval [CI], 0.44-0.80), and composite end point (HR, 0.67; 95% CI, 0.52-0.87) during a mean follow-up of 4.8 years. Subgroup analysis revealed a trend in which the beneficial effect of MV repair was not apparent when surgeries were performed in hospitals within the lowest volume quartile (P for interaction = .091). In patients who underwent surgery during active IE, MV repair was also related to a lower rate of late mortality (HR, 0.64; 95% CI, 0.48-0.85). CONCLUSIONS Mitral repair for IE has better perioperative and late outcomes than mitral replacement. Mitral repair performed by an experienced team is recommended for IE patients instead of MV replacement whenever possible, even with an active infection status.
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Affiliation(s)
- Hsiu-An Lee
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
| | - Yu-Ting Cheng
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
| | - Victor Chien-Chia Wu
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
| | - An-Hsun Chou
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
| | - Pao-Hsien Chu
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
| | - Feng-Chun Tsai
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
| | - Shao-Wei Chen
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan City, Taiwan.
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20
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Nappi F, Spadaccio C, Dreyfus J, Attias D, Acar C, Bando K. Mitral endocarditis: A new management framework. J Thorac Cardiovasc Surg 2018; 156:1486-1495.e4. [PMID: 29884490 DOI: 10.1016/j.jtcvs.2018.03.159] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 03/17/2018] [Accepted: 03/30/2018] [Indexed: 02/07/2023]
Affiliation(s)
- Francesco Nappi
- Cardiac Surgery Centre Cardiologique du Nord de Saint-Denis, Paris, France.
| | - Cristiano Spadaccio
- Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom; University of Glasgow Institute of Cardiovascular and Medical Sciences, Glasgow, United Kingdom
| | - Julien Dreyfus
- Cardiology department Centre Cardiologique du Nord de Saint-Denis, Paris, France
| | - David Attias
- Cardiology department Centre Cardiologique du Nord de Saint-Denis, Paris, France
| | - Christophe Acar
- Department of Cardiovascular Surgery, Hôpital de la Salpétrière, Paris, France
| | - Ko Bando
- Department of Cardiac Surgery, The Jikei University School of Medicine, Tokyo, Japan
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21
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van der Merwe J, Casselman F, Stockman B, Roubelakis A, Vermeulen Y, Degrieck I, Van Praet F. Endoscopic port access surgery for isolated atrioventricular valve endocarditis†. Interact Cardiovasc Thorac Surg 2018; 27:487-493. [DOI: 10.1093/icvts/ivy103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 02/22/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Johan van der Merwe
- Department of Cardiovascular and Thoracic Surgery, OLV Clinic, Aalst, Belgium
| | - Filip Casselman
- Department of Cardiovascular and Thoracic Surgery, OLV Clinic, Aalst, Belgium
| | - Bernard Stockman
- Department of Cardiovascular and Thoracic Surgery, OLV Clinic, Aalst, Belgium
| | | | - Yvette Vermeulen
- Department of Cardiovascular and Thoracic Surgery, OLV Clinic, Aalst, Belgium
| | - Ivan Degrieck
- Department of Cardiovascular and Thoracic Surgery, OLV Clinic, Aalst, Belgium
| | - Frank Van Praet
- Department of Cardiovascular and Thoracic Surgery, OLV Clinic, Aalst, Belgium
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22
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Tomšic A, Versteegh MIM, Ajmone Marsan N, van Brakel TJ, Klautz RJM, Palmen M. Early and late results of surgical treatment for isolated active native mitral valve infective endocarditis. Interact Cardiovasc Thorac Surg 2018; 26:610-616. [PMID: 29272376 DOI: 10.1093/icvts/ivx395] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 11/18/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Native mitral valve infective endocarditis (IE) is a complicated disease with high mortality and morbidity rates. Mitral valve repair (MVRep) is feasible when limited valve destruction is present. However, recurrent valve dysfunction and reintervention are common. METHODS Between January 2000 and March 2016, 83 patients underwent surgery for isolated active native mitral valve IE. We applied an early surgery, MVRep-oriented approach with progressive utilization of patch techniques to secure a durable repair; MVRep was attempted in 67% of patients. Fifty-one (61%) patients underwent MVRep (including full-ring annuloplasty in 94%) and 32 (39%) patients underwent mitral valve replacement. RESULTS Early mortality was 13%. No cases of early recurrent IE occurred. Predischarge echocardiography demonstrated good MVRep function in all, except 1 patient with residual (Grade 2+) regurgitation. The mean duration of follow-up was 3.7 years (interquartile range 1.5-8.4). For hospital survivors, 8-year overall survival rates were 92.4% (95% confidence interval 84.0-100%) and 74.2% (95% confidence interval 53.8-94.6%) for the MVRep and mitral valve replacement groups, respectively. Propensity score-adjusted Cox regression analysis revealed no significant difference in survival between the 2 groups (hazard ratio 0.359, 95% confidence interval 0.107-1.200; P = 0.096). Four reinterventions occurred, 2 in each group. Echocardiographic follow-up demonstrated excellent MVRep durability; no cases of mitral regurgitation and 1 case of mitral valve stenosis were seen. CONCLUSIONS Native mitral valve IE is linked to high mortality and morbidity rates. A durable MVRep is feasible in most patients and provides excellent mid-term durability. Mitral valve replacement is a reasonable alternative when a durable repair is not likely.
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Affiliation(s)
- Anton Tomšic
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Michel I M Versteegh
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Thomas J van Brakel
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Robert J M Klautz
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Meindert Palmen
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
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23
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Lee HA, Lin CY, Chen YC, Chen SW, Nan YY, Liu KS, Wu MY, Chang YS, Chu JJ, Lin PJ, Tsai FC. Surgical interventions of isolated active mitral valve endocarditis: Predisposing factors and impact of neurological insults on final outcome. Medicine (Baltimore) 2018. [PMID: 29538196 PMCID: PMC5882381 DOI: 10.1097/md.0000000000010054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
The feasibility and durability of mitral valve (MV) repair in active infective endocarditis (IE) has been reported, but proper management of perioperative neurological complications and surgical timing remains uncertain and may crucially affect the outcome.In this single-center retrospective observational study, patients who underwent isolated MV surgery for active native IE in our institution between August 2005 and August 2015 were reviewed and analyzed. Patients who were operated on for healed IE or who required combined procedures were excluded from this study.A total of 71 patients were enrolled in the study with a repair rate of 53.5% (n = 38). Isolated posterior leaflet lesion was found in 15 patients (21%) and was related to higher reparability (86.7%, P = .004). The overall in-hospital mortality was 10 (14.1%): 3 (7.9%) in the repair group and 7 (21.2%) in replacement group (P = .17). Prognosis was not related to age, preoperative renal function, cerebral emboli, or duration of antibiotics. The only significant predictor was postoperative intracranial hemorrhage (ICH) [odds ratio 14.628 (1.649-129.78), P = .04]. At a mean follow-up period of 43.1 months, neither recurrent endocarditis nor late cardiac death was observed in both groups.Surgical timing and procedural options of MV surgery in active native IE did not make any difference, but occurrence of ICH after surgery jeopardized the final outcome. Routine preoperative brain imaging to detect silent ICH or mycotic aneurysm and aggressive treatment of these lesions may prevent catastrophe and optimize the results.
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Affiliation(s)
- Hsiu-An Lee
- Department of Thoracic and Cardiovascular Surgery
| | - Chun-Yu Lin
- Department of Thoracic and Cardiovascular Surgery
| | - Yung-Chang Chen
- Department of Nephrology, Chang-Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | | | - Yu-Yun Nan
- Department of Thoracic and Cardiovascular Surgery
| | | | - Meng-Yu Wu
- Department of Thoracic and Cardiovascular Surgery
| | | | - Jaw-Ji Chu
- Department of Thoracic and Cardiovascular Surgery
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Kaura A, Byrne J, Fife A, Deshpande R, Baghai M, Gunning M, Whitaker D, Monaghan M, MacCarthy PA, Wendler O, Dworakowski R. Inception of the 'endocarditis team' is associated with improved survival in patients with infective endocarditis who are managed medically: findings from a before-and-after study. Open Heart 2017; 4:e000699. [PMID: 29344368 PMCID: PMC5761279 DOI: 10.1136/openhrt-2017-000699] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 10/12/2017] [Accepted: 11/07/2017] [Indexed: 11/18/2022] Open
Abstract
Objective Despite improvements in its management, infective endocarditis (IE) is associated with poor survival. The aim of this study was to evaluate the impact of a multidisciplinary endocarditis team (ET), including a cardiologist, microbiologist and a cardiac surgeon, on the outcome of patients with acute IE according to medical or surgical treatment strategies. Methods We conducted an observational before-and-after study of 196 consecutive patients with definite IE, who were treated at a tertiary reference centre between 2009 and 2015. The study was divided into two periods: period 1, before the formation of the ET (n=101), and period 2, after the formation of the ET (n=95). The role of the ET included regular multidisciplinary team meetings to confirm diagnosis, inform the type and duration of antibiotic therapy and recommend early surgery, when indicated, according to European guidelines. Results The patient demographics and predisposing conditions for IE were comparable between the two study periods. In the time period following the introduction of the ET, there was a reduction in both the time to commencement of IE-specific antibiotic therapy (4.0±4.0 days vs 2.5±3.2 days; P=0.004) and the time from suspected IE to surgery (7.8±7.3 days vs 5.3±4.2 days; P=0.004). A 12-month Kaplan-Meier survival for patients managed medically was 42.9% in the pre-ET period and 66.7% in the post-ET period (P=0.03). The involvement of the ET was a significant independent predictor of 1-year survival in patients managed medically (HR 0.24, 95% CI 0.07 to 0.87; P=0.03). Conclusions A standardised multidisciplinary team approach may lead to earlier diagnosis of IE, more appropriate individualised management strategies, expedited surgery, where indicated, and improved survival in those patients chosen for medical management, supporting the recent change in guidelines to recommend the use of a multidisciplinary team in the care of patients with IE.
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Affiliation(s)
- Amit Kaura
- Department of Cardiology and Cardiac Surgery, King's College Hospital NHS Foundation Trust, King's College Hospital, London, UK.,Department of Cardiovascular Medicine, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Jonathan Byrne
- Department of Cardiology and Cardiac Surgery, King's College Hospital NHS Foundation Trust, King's College Hospital, London, UK
| | - Amanda Fife
- Department of Microbiology, King's College Hospital NHS Foundation Trust, King's College Hospital, London, UK
| | - Ranjit Deshpande
- Department of Cardiology and Cardiac Surgery, King's College Hospital NHS Foundation Trust, King's College Hospital, London, UK
| | - Max Baghai
- Department of Cardiology and Cardiac Surgery, King's College Hospital NHS Foundation Trust, King's College Hospital, London, UK
| | - Margaret Gunning
- Department of Cardiology and Cardiac Surgery, King's College Hospital NHS Foundation Trust, King's College Hospital, London, UK
| | - Donald Whitaker
- Department of Cardiology and Cardiac Surgery, King's College Hospital NHS Foundation Trust, King's College Hospital, London, UK
| | - Mark Monaghan
- Department of Cardiology and Cardiac Surgery, King's College Hospital NHS Foundation Trust, King's College Hospital, London, UK
| | - Philip A MacCarthy
- Department of Cardiology and Cardiac Surgery, King's College Hospital NHS Foundation Trust, King's College Hospital, London, UK
| | - Olaf Wendler
- Department of Cardiology and Cardiac Surgery, King's College Hospital NHS Foundation Trust, King's College Hospital, London, UK
| | - Rafal Dworakowski
- Department of Cardiology and Cardiac Surgery, King's College Hospital NHS Foundation Trust, King's College Hospital, London, UK
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25
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Toyoda N, Itagaki S, Egorova NN, Tannous H, Anyanwu AC, El-Eshmawi A, Adams DH, Chikwe J. Real-world outcomes of surgery for native mitral valve endocarditis. J Thorac Cardiovasc Surg 2017; 154:1906-1912.e9. [DOI: 10.1016/j.jtcvs.2017.07.077] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 07/04/2017] [Accepted: 07/30/2017] [Indexed: 02/06/2023]
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26
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Surgical treatment for isolated mitral valve endocarditis: a 16-year single-centre experience. Eur J Cardiothorac Surg 2017; 53:576-581. [DOI: 10.1093/ejcts/ezx416] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 10/31/2017] [Indexed: 01/22/2023] Open
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Pettersson GB, Coselli JS, Pettersson GB, Coselli JS, Hussain ST, Griffin B, Blackstone EH, Gordon SM, LeMaire SA, Woc-Colburn LE. 2016 The American Association for Thoracic Surgery (AATS) consensus guidelines: Surgical treatment of infective endocarditis: Executive summary. J Thorac Cardiovasc Surg 2017; 153:1241-1258.e29. [PMID: 28365016 DOI: 10.1016/j.jtcvs.2016.09.093] [Citation(s) in RCA: 244] [Impact Index Per Article: 34.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 09/12/2016] [Accepted: 09/16/2016] [Indexed: 12/23/2022]
Affiliation(s)
| | - Gösta B Pettersson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio.
| | - Joseph S Coselli
- Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Tex; Texas Heart Institute, Houston, Tex
| | | | - Gösta B Pettersson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Joseph S Coselli
- Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Tex; Texas Heart Institute, Houston, Tex
| | - Syed T Hussain
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Brian Griffin
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Eugene H Blackstone
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Steven M Gordon
- Department of Infectious Disease, Cleveland Clinic, Cleveland, Ohio
| | - Scott A LeMaire
- Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Tex; Texas Heart Institute, Houston, Tex
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28
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Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del Zotti F, Dulgheru R, El Khoury G, Erba PA, Iung B, Miro JM, Mulder BJ, Plonska-Gosciniak E, Price S, Roos-Hesselink J, Snygg-Martin U, Thuny F, Tornos Mas P, Vilacosta I, Zamorano JL. 2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J 2015; 36:3075-3128. [PMID: 26320109 DOI: 10.1093/eurheartj/ehv319] [Citation(s) in RCA: 3073] [Impact Index Per Article: 341.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
MESH Headings
- Acute Kidney Injury/diagnosis
- Acute Kidney Injury/therapy
- Ambulatory Care
- Aneurysm, Infected/diagnosis
- Aneurysm, Infected/therapy
- Anti-Bacterial Agents/therapeutic use
- Antibiotic Prophylaxis
- Arrhythmias, Cardiac/diagnosis
- Arrhythmias, Cardiac/therapy
- Clinical Laboratory Techniques
- Critical Care
- Cross Infection/etiology
- Dentistry, Operative
- Diagnostic Imaging/methods
- Embolism/diagnosis
- Embolism/therapy
- Endocarditis/diagnosis
- Endocarditis/therapy
- Endocarditis, Non-Infective/diagnosis
- Endocarditis, Non-Infective/therapy
- Female
- Fibrinolytic Agents/therapeutic use
- Heart Defects, Congenital
- Heart Failure/diagnosis
- Heart Failure/therapy
- Heart Valve Diseases/diagnosis
- Heart Valve Diseases/therapy
- Humans
- Long-Term Care
- Microbiological Techniques
- Musculoskeletal Diseases/diagnosis
- Musculoskeletal Diseases/microbiology
- Musculoskeletal Diseases/therapy
- Myocarditis/diagnosis
- Myocarditis/therapy
- Neoplasms/complications
- Nervous System Diseases/diagnosis
- Nervous System Diseases/microbiology
- Nervous System Diseases/therapy
- Patient Care Team
- Pericarditis/diagnosis
- Pericarditis/therapy
- Postoperative Complications/etiology
- Postoperative Complications/prevention & control
- Pregnancy
- Pregnancy Complications, Cardiovascular/diagnosis
- Pregnancy Complications, Cardiovascular/therapy
- Prognosis
- Prosthesis-Related Infections/diagnosis
- Prosthesis-Related Infections/therapy
- Recurrence
- Risk Assessment
- Risk Factors
- Splenic Diseases/diagnosis
- Splenic Diseases/therapy
- Thoracic Surgical Procedures
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29
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Myers PO, Cikirikcioglu M, Kalangos A. Biodegradable materials for surgical management of infective endocarditis: new solution or a dead end street? BMC Surg 2014; 14:48. [PMID: 25087015 PMCID: PMC4131057 DOI: 10.1186/1471-2482-14-48] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 07/24/2014] [Indexed: 01/29/2023] Open
Abstract
Background One third of patients with infective endocarditis will require operative intervention. Given the superiority of valve repair over valve replacement in many indications other than endocarditis, there has been increasing interest and an increasing number of reports of excellent results of valve repair in acute infective endocarditis. The theoretically ideal material for valve repair in this setting is non-permanent, “vanishing” material, not at risk of seeding or colonization. The goal of this contribution is to review currently available data on biodegradable materials for valve repair in infective endocarditis. Discussion Rigorous electronic and manual literature searches were conducted to identify reports of biodegradable materials for valve repair in infective endocarditis. Articles were identified in electronic database searches of Medline, Embase and the Cochrane Library, using a predetermined search strategy. 49 manuscripts were included in the review. Prosthetic materials needed for valve repair can be summarized into annuloplasty rings to remodel the mitral or tricuspid annulus, and patch materials to replace resected valvar tissue. The commercially available biodegradable annuloplasty ring has shown interesting clinical results in a single-center experience; however further data is required for validation and longer follow-up. Unmodified extra-cellular matrix patches, such as small intestinal submucosa, have had promising initial experimental and clinical results in non-infected valve repair, although in valve repair for endocarditis has been reported in only one patient, and concerns have been raised regarding their mechanical stability in an infected field. Summary These evolving biodegradable devices offer the potential for valve repair with degradable materials replaced with autologous tissue, which could further improve the results of valve repair for infective endocarditis. This is an evolving field with promising experimental or initial clinical results, however long-term outcomes are lacking and further data is necessary to validate this theoretically interesting approach to infective endocarditis.
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Affiliation(s)
- Patrick O Myers
- Cardiovascular Surgery, Geneva University Hospitals & Faculty of Medicine, 4 rue Gabrielle-Perret-Gentil, 1211 Geneva, Switzerland.
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30
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Vohra HA, Whistance RN, Hechadi J, Kerchove LD, Fuller H, Noirhomme P, El Khoury G. Long-term outcomes of concomitant aortic and mitral valve repair. J Thorac Cardiovasc Surg 2014; 148:454-60. [DOI: 10.1016/j.jtcvs.2013.10.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Revised: 09/19/2013] [Accepted: 10/06/2013] [Indexed: 10/25/2022]
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García-Alonso CJ, Ferrer E, Vallejo N, Delgado L, Pedro-Botet ML, Ruyra X, Bayés-Genis A. [Mitral valve repair in the course of active infectious endocarditis. Study of four patients]. Med Clin (Barc) 2013; 140:504-7. [PMID: 23510612 DOI: 10.1016/j.medcli.2012.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 12/05/2012] [Accepted: 12/13/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND OBJECTIVE Mitral valve (MV) repair is the preferred surgical treatment for degenerative mitral regurgitation (MR). However, questions remain about the efficacy of MV repair when performed for MR caused by infective endocarditis (IE), particularly during its active phase. Although several observational studies have suggested the superiority of MV repair over replacement in patients undergoing surgery for IE, many centres are still opting for valve replacement because of its technical feasibility and reproducibility. In the following document we expose the experience of our hospital. PATIENTS AND METHOD We present a series of 4 patients who recently underwent surgery for IE during its active phase. Epidemiological and clinical characteristics are discussed. RESULTS All patients underwent different MV repair techniques. No relapse or reinfection has been reported. All patients present MR grades 0 or iI/ivIV at follow up. CONCLUSIONS Even during the active phase of IE, MV repair is a feasible technique with good postoperatory results.
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Affiliation(s)
- Carlos J García-Alonso
- Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España.
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Reconstruction of anterior mitral leaflet using autologous pericardial patch combined with posterior leaflet sliding for active infective endocarditis. Gen Thorac Cardiovasc Surg 2013; 62:234-7. [PMID: 23612922 DOI: 10.1007/s11748-013-0252-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Accepted: 04/11/2013] [Indexed: 10/26/2022]
Abstract
We report a case of active infective endocarditis in a young adult, affecting the anterior and posterior leaflets extensively. The patient underwent a mitral valve repair with extended sliding repair on the posterior leaflet and reconstruction using an autologous pericardial patch supported by an artificial chord on the anterior leaflet. Although we finally needed commissure closing for successful repair, we aggressively achieved a repair-oriented strategy using several techniques in a young patient who may have required mitral valve replacement.
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Malhotra A, Prendergast BD. Evaluating treatment options for patients with infective endocarditis: when is it the right time for surgery? Future Cardiol 2012; 8:847-61. [DOI: 10.2217/fca.12.46] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Infective endocarditis remains a life-threatening condition with an unchanging incidence and mortality of nearly 30% at 1 year. Surgery is required in 25–50% of acute infections and 20–40% of patients during convalescence. Operative procedures are often technically challenging and high-risk, often due to coexistent multisystem disease. However, international guidelines provide clear indications for surgical intervention, which are applicable for the majority of patients. These are not, however, supported by particularly robust clinical evidence and decision-making often needs to be tailored to the advancing age of the overall patient cohort, the presence of multisystem disease, comorbidities, prior antibiotic therapy of varying duration and the availability of surgical expertise. Native valve endocarditis will be the initial focus of this article, along with subgroups including prosthetic valve endocarditis. We present the treatment options for patients with infective endocarditis, evaluate the evidence-base that supports current clinical practice and attempt to provide an insight and subsequent recommendations for the timing of surgery.
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Affiliation(s)
- Aneil Malhotra
- Department of Cardiology, The John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK
| | - Bernard D Prendergast
- Department of Cardiology, The John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK
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Carrascal Y, Valenzuela H, Fernández M, Arce N. Mitral approach in prosthetic endocarditis with calcified annulus and abscess. Asian Cardiovasc Thorac Ann 2012; 20:217-20. [PMID: 22499980 DOI: 10.1177/0218492311435924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abscess resection and prosthesis reimplantation is the only effective treatment for mitral prosthesis endocarditis with extensive annular abscess, but it has high morbidity and mortality when associated with severe mitral annular calcification in the atrial and ventricular walls. We describe a technique that allows repair of the abscess cavity, reconstruction of the annulus, and implantation of a new mitral prosthesis when there is severe adjacent myocardial calcification, so decreasing the reoperation risk.
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de Kerchove L, Price J, Tamer S, Glineur D, Momeni M, Noirhomme P, ElKhoury G. Extending the scope of mitral valve repair in active endocarditis. J Thorac Cardiovasc Surg 2012; 143:S91-5. [PMID: 22306214 DOI: 10.1016/j.jtcvs.2012.01.049] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2011] [Revised: 12/26/2011] [Accepted: 01/16/2012] [Indexed: 11/17/2022]
Abstract
OBJECTIVE During the last 2 decades, we have applied a repair-oriented surgical approach to patients with active mitral valve endocarditis. We retrospectively analyzed the long-term outcomes with this repair-oriented approach. METHOD Between 1991 and 2010, 137 patients underwent operation for active mitral valve endocarditis; of these, 109 patients (80%) had mitral valve repair and represent the study cohort. Repair techniques without patch extension (no-patch techniques) include triangular or quadrangular resection (n = 49), sliding plasty (n = 24), neochordae (n = 18), chordal transfer (n = 12), and others (n = 5). Repair techniques using patch extension (patch techniques) included pericardium (n = 42), tricuspid autograft (n = 8), flip-over technique (n = 7), and partial mitral valve homograft (n = 5). Patches were used in 67 patients (61%). Ring annuloplasty was performed in 60 patients, and a pericardial band was used in 13 patients. Clinical and echocardiographic follow-up were performed. Median follow-up was 48 months. RESULTS Hospital mortality was 16%. At 8 years, overall survival was 62% ± 10% with no differences between patients with or without patch repair (P = .5). Freedom from mitral valve repair failure was 81% ± 14% in patients with patch repair and 90% ± 10% in patients without patch repair (P = .09). The rate of thromboembolic or bleeding event was 1% per patient-year, and the rate of endocarditis recurrence was 0.3% per patient-year. Univariable predictors of mortality were age more than 70 years (P < .0001), perivalvular abscess (P = .002), diabetes mellitus (P = .0002), and renal failure (P = .04). Predictors of repair failure were renal failure (P = .035) and perivalvular abscess (P = .033). CONCLUSIONS In active mitral valve endocarditis, a repair-oriented surgical approach achieves a reparability rate of 80% with acceptable morbidity and good long-term results. The use of patch techniques offers a durability rate that approximates the rate obtained with the no-patch techniques.
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Affiliation(s)
- Laurent de Kerchove
- Division of Cardiothoracic and Vascular Surgery, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
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36
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Prise en charge précoce des insuffisances aortique et mitrale aiguës en réanimation. MEDECINE INTENSIVE REANIMATION 2012. [DOI: 10.1007/s13546-012-0461-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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37
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Gelsomino S, Maessen JG, van der Veen F, Livi U, Renzulli A, Lucà F, Carella R, Crudeli E, Rubino A, Rostagno C, Russo C, Borghetti V, Beghi C, De Bonis M, Gensini GF, Lorusso R. Emergency surgery for native mitral valve endocarditis: the impact of septic and cardiogenic shock. Ann Thorac Surg 2012; 93:1469-76. [PMID: 22342063 DOI: 10.1016/j.athoracsur.2011.11.025] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Revised: 11/04/2011] [Accepted: 11/07/2011] [Indexed: 12/31/2022]
Abstract
BACKGROUND Limited information exists about the real impact of the etiology of shock on early and late outcome after emergency surgery in acute native mitral valve endocarditis (ANMVE). This multicenter study analyzed the impact of the etiology of shock on early and late outcome in patients with ANMVE. METHODS Data were collected in eight institutions. Three hundred-seventy-nine ANMVE patients undergoing surgery on an emergency basis between May 1991 and December 2009 were eligible for the study. According to current criteria used for the differential diagnosis of shock, patients were retrospectively assigned to one of three groups: group 1, no shock (n=154), group 2, cardiogenic shock (CS [n=118]), and group 3, septic shock (SS [n=107]). Median follow-up was 69.8 months. RESULTS Early mortality was significantly higher in patients with SS (p<0.001). At multivariable logistic regression analysis, compared with patients with CS, patients with SS had more than 3.8 times higher risk of death. That rose to more than 4 times versus patients without shock. In addition, patients with SS had 4.2 times and 4.3 times higher risk of complications compared with patients with CS and without shock, respectively. Sepsis was also an independent predictor of prolonged artificial ventilation (p=0.04) and stroke (p=0.003) whereas CS was associated with a higher postoperative occurrence of low output syndrome and myocardial infarction (p<0.001). No difference was detected between groups in 18-year survival, freedom from endocarditis, and freedom from reoperation. CONCLUSIONS Our study suggests that emergency surgery for ANMVE in patients with CS achieved satisfactory early and late results. In contrast, the presence of SS was linked to dismal early prognosis. Our findings need to be confirmed by further larger studies.
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Affiliation(s)
- Sandro Gelsomino
- Department of Heart and Vessels, Careggi Hospital, Florence, Italy.
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Evans CF, Gammie JS. Surgical Management of Mitral Valve Infective Endocarditis. Semin Thorac Cardiovasc Surg 2011; 23:232-40. [DOI: 10.1053/j.semtcvs.2011.07.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2011] [Indexed: 12/11/2022]
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Musci M, Hübler M, Amiri A, Stein J, Kosky S, Weng Y, Pasic M, Hetzer R. Repair for active infective atrioventricular valve endocarditis: 23-year single center experience. Clin Res Cardiol 2011; 100:993-1002. [DOI: 10.1007/s00392-011-0331-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Accepted: 05/31/2011] [Indexed: 10/18/2022]
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40
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Byrne JG, Rezai K, Sanchez JA, Bernstein RA, Okum E, Leacche M, Balaguer JM, Prabhakaran S, Bridges CR, Higgins RS. Surgical Management of Endocarditis: The Society of Thoracic Surgeons Clinical Practice Guideline. Ann Thorac Surg 2011; 91:2012-9. [DOI: 10.1016/j.athoracsur.2011.01.106] [Citation(s) in RCA: 136] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Revised: 01/11/2011] [Accepted: 01/18/2011] [Indexed: 11/26/2022]
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41
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Surgical results of active infective native mitral valve endocarditis: repair versus replacement. Eur J Cardiothorac Surg 2011; 40:834-9. [DOI: 10.1016/j.ejcts.2011.01.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Revised: 12/28/2010] [Accepted: 01/05/2011] [Indexed: 11/18/2022] Open
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Nwaejike N, Ascione R. Mitral valve repair for disruptive acute endocarditis: extensive replacement of posterior leaflet with bovine pericardium. J Card Surg 2010; 26:31-3. [PMID: 21158916 DOI: 10.1111/j.1540-8191.2010.01169.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Surgery for infective mitral valve endocarditis should include resection/debridement of all infected tissue, but this may leave behind insufficient-autologous mitral valve tissue for an adequate repair. Effective mitral valve repair using only bovine pericardium is feasible even in the presence of extensive endocarditis involving a large part of the free margin of the affected leaflet.
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Affiliation(s)
- Nnamdi Nwaejike
- Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, United Kingdom.
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43
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Situaciones especiales. Endocarditis mitral. CIRUGIA CARDIOVASCULAR 2010. [DOI: 10.1016/s1134-0096(10)70083-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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44
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Abstract
Cardiac complications caused by infective endocarditis (IE) are varied and frequently life-threatening. This article focuses on new data related to several complications, and summarizes the indications, timing, and type of valve surgery recommended in the management of IE. Several recent studies using propensity score techniques have resulted in disparate conclusions and underscore the need for randomized prospective studies to better address whether and when surgery should be performed in patients with IE. Mitral valve repair is an exciting new development in surgical methodology and probably will have increased application over the next two decades. Excellent reviews related to periannular abscesses, fistulae, acute coronary syndrome, and pericarditis have been published recently and are also summarized.
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45
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Results of surgical treatment of infective endocarditis. COR ET VASA 2010. [DOI: 10.33678/cor.2010.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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46
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Midterm Results of Valve Repair With a Biodegradable Annuloplasty Ring for Acute Endocarditis. Ann Thorac Surg 2010; 89:1180-5. [DOI: 10.1016/j.athoracsur.2010.01.041] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Revised: 01/15/2010] [Accepted: 01/20/2010] [Indexed: 10/19/2022]
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47
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Habib G, Hoen B, Tornos P, Thuny F, Prendergast B, Vilacosta I, Moreillon P, de Jesus Antunes M, Thilen U, Lekakis J, Lengyel M, Müller L, Naber CK, Nihoyannopoulos P, Moritz A, Luis Zamorano J. Guía de práctica clínica para prevención, diagnóstico y tratamiento de la endocarditis infecciosa (nueva versión 2009). Rev Esp Cardiol 2009. [DOI: 10.1016/s0300-8932(09)73131-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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48
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Ushijima T, Kikuchi Y, Takata M, Yamamoto Y, Kawachi K, Watanabe G. Commissural autologous pericardial patch repair: a novel technique for active mitral valve endocarditis involving the mitral annulus. Ann Thorac Surg 2009; 88:e29-30. [PMID: 19699883 DOI: 10.1016/j.athoracsur.2009.06.079] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2009] [Revised: 04/28/2009] [Accepted: 06/09/2009] [Indexed: 11/15/2022]
Abstract
In patients with massive destruction caused by mitral endocarditis, surgical valve repair remains a challenging issue. Although several procedures have previously been introduced, no standard method for complicated lesions has been established. We describe a technique of mitral valve repair for extensive destructive endocarditis involving both leaflets and the mitral annulus that has provided satisfactory initial results in 2 patients. This procedure is believed to be technically simple and beneficial in terms of mitral repair for active endocarditis.
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Affiliation(s)
- Teruaki Ushijima
- Division of Cardiac Surgery, Tokyo Medical University, Tokyo, Japan.
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49
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Shimokawa T, Kasegawa H, Matsuyama S, Seki H, Manabe S, Fukui T, Morita S, Takanashi S. Long-Term Outcome of Mitral Valve Repair for Infective Endocarditis. Ann Thorac Surg 2009; 88:733-9; discussion 739. [DOI: 10.1016/j.athoracsur.2009.05.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2009] [Revised: 05/08/2009] [Accepted: 05/13/2009] [Indexed: 10/20/2022]
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50
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Habib G, Hoen B, Tornos P, Thuny F, Prendergast B, Vilacosta I, Moreillon P, de Jesus Antunes M, Thilen U, Lekakis J, Lengyel M, Müller L, Naber CK, Nihoyannopoulos P, Moritz A, Zamorano JL, Vahanian A, Auricchio A, Bax J, Ceconi C, Dean V, Filippatos G, Funck-Brentano C, Hobbs R, Kearney P, McDonagh T, McGregor K, Popescu BA, Reiner Z, Sechtem U, Sirnes PA, Tendera M, Vardas P, Widimsky P, Vahanian A, Aguilar R, Bongiorni MG, Borger M, Butchart E, Danchin N, Delahaye F, Erbel R, Franzen D, Gould K, Hall R, Hassager C, Kjeldsen K, McManus R, Miro JM, Mokracek A, Rosenhek R, San Roman Calvar JA, Seferovic P, Selton-Suty C, Uva MS, Trinchero R, van Camp G. Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009): the Task Force on the Prevention, Diagnosis, and Treatment of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and the International Society of Chemotherapy (ISC) for Infection and Cancer. Eur Heart J 2009; 30:2369-413. [PMID: 19713420 DOI: 10.1093/eurheartj/ehp285] [Citation(s) in RCA: 1213] [Impact Index Per Article: 80.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Gilbert Habib
- Service de Cardiologie, CHU La Timone, Bd Jean Moulin, 13005 Marseille, France.
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