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Demir F, Varan C, Erdem S, Atmış A, Akbaş T, Subaşı B, Güzel Y, Özbarlas N. Infective endocarditis in childhood: a single-centre experience of 26 years. Cardiol Young 2023; 33:1950-1955. [PMID: 36419327 DOI: 10.1017/s1047951122003419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The aim of this study was to present the clinical and microbiological characteristics of patients with infective endocarditis.A retrospective evaluation was made of patients diagnosed with infective endocarditis between 1995 and 2021. The clinical and laboratory characteristics of the patients were recorded together with conditions constituting a risk for the development of endocarditis, treatment, and surgical outcomes.Evaluation was made of 68 patients with a mean age of 7.3 years (3 months-17 years), diagnosed with infective endocarditis. An underlying cause of CHD was determined in 47 (69%) patients and rheumatic valve disease in 3 (4.4%). There was no structural heart disease in 18 (26%) patients of whom 13 of them had other risk factors. A causative organism was found in 41 (60%) cases, and the microorganism most often determined was viridans group streptococcus. No difference was determined between the patients diagnosed before and after 2007 in respect of the frequency of viridans streptococcus (p > 0.05). Septic emboli were seen in 18 (26%) patients, of which 17 required surgical treatments. In 5 of 11 (16.6%) patients with mortality, the agent was S. aureus. Of the total 28 (41%) patients were evaluated as hospital-acquired endocarditis. The most frequently determined agents in this group were staphylococcus epidermidis and S. aureus.Although CHDs continue to be the greatest risk factor for endocarditis, there is an increasing frequency of endocarditis in patients with no structural heart disease. Mortality rates are still high in infective endocarditis, especially in S. aureus endocarditis.
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Affiliation(s)
- Fadli Demir
- Department of Pediatric Cardiology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Celal Varan
- Department of Pediatric Cardiology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Sevcan Erdem
- Department of Pediatric Cardiology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Anıl Atmış
- Department of Pediatric Cardiology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Tolga Akbaş
- Department of Pediatric Cardiology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Berivan Subaşı
- Department of Pediatric Cardiology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Yasin Güzel
- Department of Pediatric Cardiovascular Surgery, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Nazan Özbarlas
- Department of Pediatric Cardiology, Faculty of Medicine, Çukurova University, Adana, Turkey
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Wu DM, Zhu MZL, Buratto E, Brizard CP, Konstantinov IE. Aortic valve surgery in children with infective endocarditis. Semin Thorac Cardiovasc Surg 2023:S1043-0679(23)00038-2. [PMID: 36898419 DOI: 10.1053/j.semtcvs.2023.02.004] [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: 01/15/2023] [Accepted: 02/23/2023] [Indexed: 03/12/2023]
Abstract
There is limited data on the outcomes of children who undergo surgery for aortic valve infective endocarditis (IE), and the optimal surgical approach remains controversial. We investigated the long-term outcomes of surgery for aortic valve IE in children, with a particular focus on the Ross procedure. A retrospective review of all children who underwent surgery for aortic valve IE was performed at a single institution. Between 1989 and 2020, 41 children underwent surgery for aortic valve IE, of whom 16 (39.0%) underwent valve repair, 13 (31.7%) underwent the Ross procedure, 9 (21.9%) underwent a homograft root replacement, and 3 (7.3%) underwent a mechanical valve replacement. Median age was 10.1 years (interquartile range [IQR], 5.4-14.1). The majority of children (82.9%, 34/41) had underlying congenital heart disease, while 39.0% (16/41) had previous heart surgery. Operative mortality was 0.0% (0/16) for repair, 15.4% (2/13) for the Ross procedure, 33.3% (3/9) for homograft root replacement, and 33.3% (1/3) for mechanical replacement. Survival at 10 years was 87.5% for repair, 74.1% for Ross, and 66.7% for homograft (p>0.05). Freedom from reoperation at 10 years was 30.8% for repair, 63.0% for Ross, and 26.3% for homograft (p=0.15 for Ross vs. repair, p=0.002 for Ross vs. homograft). Children undergoing surgery for aortic valve IE have acceptable long-term survival, although the need for long-term reintervention is significant. The Ross procedure appears to be the optimal choice when repair is not feasible.
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Affiliation(s)
- Damien M Wu
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia
| | - Michael Z L Zhu
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia
| | - Edward Buratto
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia
| | - Christian P Brizard
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia; Melbourne Children's Centre for Cardiovascular Genomics and Regenerative Medicine, Melbourne, Australia
| | - Igor E Konstantinov
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia; Melbourne Children's Centre for Cardiovascular Genomics and Regenerative Medicine, Melbourne, Australia.
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Agrawal A, Arockiam AD, Jamil Y, El Dahdah J, Honnekeri B, Chedid El Helou M, Kassab J, Wang TKM. Contemporary risk models for infective endocarditis surgery: a narrative review. Ther Adv Cardiovasc Dis 2023; 17:17539447231193291. [PMID: 37646184 PMCID: PMC10469256 DOI: 10.1177/17539447231193291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 07/21/2023] [Indexed: 09/01/2023] Open
Abstract
Infective endocarditis is a complex heterogeneous condition involving the infection of the endocardium and heart valves, leading to severe complications, including death. Surgery is often indicated in patients with infective endocarditis but is associated with elevated risk compared with other forms of cardiac surgery. Risk models play an important role in many cardiac surgeries as they can help inform clinicians and patients regarding procedural risk, decision-making to proceed or not, and influence perioperative management; however, they remain under-utilized in the infective endocarditis settings. Another crucial role of such risk models is to assess predicted versus found mortality, thereby allowing an assessment of institutional performance in infective endocarditis surgery. Traditionally, general cardiac surgery risk models such as European System for Cardiac Operative Risk Evaluation (EuroSCORE), EuroSCORE II, and Society of Thoracic Surgeon's score have been applied to endocarditis surgery. However, there has been the development of many endocarditis surgery-specific scores over the last decade. This review aims to discuss clinical characteristics and applications of all contemporary risk scores in the setting of surgical treatment of infective endocarditis.
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Affiliation(s)
- Ankit Agrawal
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Aro Daniela Arockiam
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Yasser Jamil
- Yale-Waterbury, Department of Internal Medicine, Yale School of Medicine, Waterbury, CT, USA
| | - Joseph El Dahdah
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Bianca Honnekeri
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Michel Chedid El Helou
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Joseph Kassab
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Tom Kai Ming Wang
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Main Campus, J1-5, Cleveland, OH 44195, USA
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Li J, Zilz C, Floerchinger B, Holzamer A, Camboni D, Schach C, Schmid C, Rupprecht L. Long-Term Results of Patch Repair in Destructive Valve Endocarditis. Thorac Cardiovasc Surg 2023; 71:22-28. [PMID: 33383590 DOI: 10.1055/s-0040-1721462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Treatment of destructive endocarditis with abscess formation is a surgical challenge and associated with significant morbidity and mortality. A root replacement is often performed in case of an annular abscess. This retrospective study was designed to assess the long-term outcome of extensive debridement and patch reconstruction as an alternative approach. METHODS Between November 2007 and November 2016, a selected group of 79 patients (29.6% of all surgical endocarditis cases) with native valve endocarditis (NVE, 53.2%) or prosthetic valve endocarditis (PVE, 46.8%) valve endocarditis underwent surgical therapy with extensive annular debridement and patch reconstruction. Their postoperative course, freedom from recurrent endocarditis, and survival at 1, 5, and 7 years were evaluated. RESULTS About two-thirds of patients were in a stable condition, one-third of patients were in a critical state. The median logistic EuroSCORE I was 17%. Infected tissue was removed, and defect closure was performed, either with autologous pericardium for small defects, or with bovine pericardium for larger defects. Overall, in-hospital mortality was 11.3% (NVE: 9.7%, PVE: 13.2%; p = 0.412). In single valve endocarditis survival at 1, 5, and 7 years was 81, 72, 72%, respectively for NVE, and 80, 57, 57%, respectively for PVE (p = 0.589), whereas in multiple valve endocarditis survival at 1, 5, and 7 years was 82, 82, 82% for NVE, and 61, 61, and 31%, respectively for PVE (p = 0.132). Confirmed late reinfection was very low. CONCLUSION Surgical treatment of destructive endocarditis with abscess formation using patch repair techniques offers acceptable early and long-term results. The relapse rate was low. PVE and involvement of multiple valves were associated with worse outcomes.
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Affiliation(s)
- Jing Li
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Christian Zilz
- Department of Occupational, Social and Environmental Medicine, Ludwig-Maximilian University Hospital Munich, Munich, Germany
| | - Bernhard Floerchinger
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Andreas Holzamer
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Daniele Camboni
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Christian Schach
- Department of Internal Medicine II-Cardiology, University Medical Center Regensburg, Regensburg, Germany
| | - Christof Schmid
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Leopold Rupprecht
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
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Wu DM, Buratto E, Schulz A, Zhu MZL, Ivanov Y, Ishigami S, Brizard CP, Konstantinov IE. Outcomes of mitral valve repair in children with infective endocarditis: a single-center experience. Semin Thorac Cardiovasc Surg 2022; 35:339-347. [PMID: 35594978 DOI: 10.1053/j.semtcvs.2022.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 05/10/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Mitral valve infective endocarditis (IE) in children is rare, and there are few reports on the outcomes of surgery in these patients. This study investigated the long-term outcomes of mitral valve repair in children with IE. METHODS Data were retrospectively obtained from medical records and correspondence. Univariable regression analyses were performed and outcomes including survival and freedom from reoperation were analysed using the Kaplan-Meier method. RESULTS Surgery for native mitral valve IE was performed in 39 patients between 1987 and 2020. Of these, 92.3% (36/39) of patients underwent mitral valve repair, while 7.7% (3/39) required replacement. Median age was 8 years. Preoperatively, 80.5% (29/36) of patients had moderate or greater mitral regurgitation. Congenital heart disease was present in 38.9% (14/36), while 11.1% (4/36) had rheumatic heart disease and 25.0% (9/36) had prior cardiac surgery. Postoperatively, only 1 patient (2.8%, 1/36) had moderate or greater residual mitral regurgitation. There were 2 early deaths (5.6%, 2/36), with survival being 94.1% (95%CI, 78.5-98.5) at 15-years. At 10-years, freedom from reoperation was 62.9% (95%CI, 41.0-78.5) while freedom from mitral valve replacement was 80.2% (95%CI, 55.5-92.3). Larger vegetation size was a risk factor for embolic events both pre- and postoperatively (OR 1.15, p=0.02). CONCLUSIONS Mitral valve repair is feasible in the majority of children requiring surgery for mitral valve IE. Survival is excellent, and at 10-years, approximately two-thirds of patients are free from mitral reoperation, and 80% are free from replacement. Larger vegetation size is associated with increased risk embolic events.
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Affiliation(s)
- Damien M Wu
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne; Department of Paediatrics, University of Melbourne, Melbourne
| | - Edward Buratto
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne; Department of Paediatrics, University of Melbourne, Melbourne; Heart Research Group, Murdoch Children's Research Institute, Melbourne
| | - Antonia Schulz
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne
| | - Michael Z L Zhu
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne; Department of Paediatrics, University of Melbourne, Melbourne
| | - Yaroslav Ivanov
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne
| | - Shuta Ishigami
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne
| | - Christian P Brizard
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne; Department of Paediatrics, University of Melbourne, Melbourne; Heart Research Group, Murdoch Children's Research Institute, Melbourne; Melbourne Centre for Cardiovascular Genomics and Regenerative Medicine, Melbourne
| | - Igor E Konstantinov
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne; Department of Paediatrics, University of Melbourne, Melbourne; Heart Research Group, Murdoch Children's Research Institute, Melbourne; Melbourne Centre for Cardiovascular Genomics and Regenerative Medicine, Melbourne.
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Impact of an In-Hospital Endocarditis Team and a State-Wide Endocarditis Network on Perioperative Outcomes. J Clin Med 2021; 10:jcm10204734. [PMID: 34682856 PMCID: PMC8541635 DOI: 10.3390/jcm10204734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/06/2021] [Accepted: 10/06/2021] [Indexed: 11/28/2022] Open
Abstract
Background: Infective endocarditis (IE) requires multidisciplinary management. We established an endocarditis team within our hospital in 2011 and a state-wide endocarditis network with referring hospitals in 2015. We aimed to investigate their impact on perioperative outcomes. Methods: We retrospectively analyzed data from patients operated on for IE in our center between 01/2007 and 03/2018. To investigate the impact of the endocarditis network on referral latency and pre-operative complications we divided patients into two eras: before (n = 409) and after (n = 221) 01/2015. To investigate the impact of the endocarditis team on post-operative outcomes we conducted multivariate binary logistic regression analyses for the whole population. Kaplan–Meier estimates of 5-year survival were reported. Results: In the second era, after establishing the endocarditis network, the median time from symptoms to referral was halved (7 days (interquartile range: 2–19) vs. 15 days (interquartile range: 6–35)), and pre-operative endocarditis-related complications were reduced, i.e., stroke (14% vs. 27%, p < 0.001), heart failure (45% vs. 69%, p < 0.001), cardiac abscesses (24% vs. 34%, p = 0.018), and acute requirement of hemodialysis (8% vs. 14%, p = 0.026). In both eras, a lack of recommendations from the endocarditis team was an independent predictor for in-hospital mortality (adjusted odds ratio: 2.12, 95% CI: 1.27–3.53, p = 0.004) and post-operative stroke (adjusted odds ratio: 2.23, 95% CI: 1.12–4.39, p = 0.02), and was associated with worse 5-year survival (59% vs. 40%, log-rank < 0.001). Conclusion: The establishment of an endocarditis network led to the earlier referral of patients with fewer pre-operative endocarditis-related complications. Adhering to endocarditis team recommendations was an independent predictor for lower post-operative stroke and in-hospital mortality, and was associated with better 5-year survival.
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2020 ACC/AHA guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Thorac Cardiovasc Surg 2021; 162:e183-e353. [PMID: 33972115 DOI: 10.1016/j.jtcvs.2021.04.002] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O'Gara PT, Rigolin VH, Sundt TM, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021; 143:e72-e227. [PMID: 33332150 DOI: 10.1161/cir.0000000000000923] [Citation(s) in RCA: 509] [Impact Index Per Article: 169.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O'Gara PT, Rigolin VH, Sundt TM, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2021; 77:e25-e197. [PMID: 33342586 DOI: 10.1016/j.jacc.2020.11.018] [Citation(s) in RCA: 709] [Impact Index Per Article: 236.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O'Gara PT, Rigolin VH, Sundt TM, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021; 143:e35-e71. [PMID: 33332149 DOI: 10.1161/cir.0000000000000932] [Citation(s) in RCA: 313] [Impact Index Per Article: 104.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
AIM This executive summary of the valvular heart disease guideline provides recommendations for clinicians to diagnose and manage valvular heart disease as well as supporting documentation to encourage their use. METHODS A comprehensive literature search was conducted from January 1, 2010, to March 1, 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, Cochrane, Agency for Healthcare Research and Quality Reports, and other selected database relevant to this guideline. Structure: Many recommendations from the earlier valvular heart disease guidelines have been updated with new evidence and provides newer options for diagnosis and treatment of valvular heart disease. This summary includes only the recommendations from the full guideline which focus on diagnostic work-up, the timing and choice of surgical and catheter interventions, and recommendations for medical therapy. The reader is referred to the full guideline for graphical flow charts, text, and tables with additional details about the rationale for and implementation of each recommendation, and the evidence tables detailing the data considered in developing these guidelines.
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Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O’Gara PT, Rigolin VH, Sundt TM, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary. J Am Coll Cardiol 2021; 77:450-500. [DOI: 10.1016/j.jacc.2020.11.035] [Citation(s) in RCA: 272] [Impact Index Per Article: 90.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Diab D, Haziza F, Russel S, de Lentdecker P, Lanzac E, Debauchez M, Benamer H. [Surgical treatment of infective endocarditis: Surgical indications, complications, intrahospital and long-term mortality]. Ann Cardiol Angeiol (Paris) 2020; 69:385-391. [PMID: 33067007 DOI: 10.1016/j.ancard.2020.09.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 09/23/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND In addition to medical treatment, half of the patients with infective endocarditis (IE) receive surgical treatment. Despite clear recommendations on the indications and the operating delays, the decision remains difficult and must take into consideration several factors. METHODS A retrospective study was performed at Foch Hospital. All patients operated for IE between 2005 and 2018 were included. Patient characteristics, indications and operating delays, as well as intrahospital mortality, were noted. Patient follow-up was provided by phone calls. RESULTS Fifty-two patients were operated on for IE between 2005 and 2018. The most frequent surgical indications were the presence of a massive symptomatic regurgitation, an uncontrolled infection and large vegetations with embolism. The average operative delay was 13.2 days with 56.5% of patients operated within the first 10 days. The most common postoperative complications were acute kidney injury (AKI) in 57.7% of cases, with 9.6% of dialysis, shock in 50% of cases, rhythm disorders in 40.4% of cases, infectious complications in 19.2% of cases, conductive disorders in 25% of cases, of which 17.3% require a definitive pacemaker implementation. The intrahospital mortality was 7.7% and the average length of hospital stay was 35 days. Survival at one year and 5 years was 95% and 85%, respectively. CONCLUSION The indications and the operating delays were conformed to international recommendations. Intrahospital and long-term mortality rate was low.
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Affiliation(s)
- D Diab
- Hôpital Foch, 40, rue Worth, 92150 Suresnes, France.
| | - F Haziza
- Hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - S Russel
- Hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - P de Lentdecker
- Institut mutualiste Monsouris, 42, boulevard Jourdan, 75014 Paris, France
| | - E Lanzac
- Institut mutualiste Monsouris, 42, boulevard Jourdan, 75014 Paris, France
| | - M Debauchez
- Institut mutualiste Monsouris, 42, boulevard Jourdan, 75014 Paris, France
| | - H Benamer
- Hôpital Foch, 40, rue Worth, 92150 Suresnes, France; Institut Jacques Cartier, ICPS Ramsay Générale de santé, 6, avenue du noyer Lambert, 91300 Massy, France; Collège de médecine des hôpitaux de Paris, Paris, France
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Rohn V, Laca B, Horn M, Vlk L, Antonova P, Mosna F. Surgery in drug use-associated infective endocarditis: long-term survival is negatively affected by recurrence. Interact Cardiovasc Thorac Surg 2020; 30:528-534. [PMID: 31886857 DOI: 10.1093/icvts/ivz302] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 11/08/2019] [Accepted: 11/21/2019] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES The prevalence of infectious endocarditis (IE) in intravenous drug users (IDUs) is increasing, and the number of patients who need surgery is also rising. Relatively little is known about the short-term and long-term outcomes of these operations. METHODS This study is a retrospective analysis of our institutional results, focussing on risk factors for perioperative death, major adverse events and long-term survival. A total of 50 of the 66 (75.75%) patients had postoperative follow-up, and the mean follow-up time was 53.9 ± 9.66 months. Patients were divided into 2 groups depending on whether they were having their first operation or were being reoperated for recurrent IE. RESULTS From March 2006 to December 2015, a total of 158 patients underwent surgery for IE; 72 (45.6%) of them were identified as active IDUs. The operative mortality in IDUs was 8.33% (6 patients), with no significant difference between the 2 groups (P = 0.6569). Survival rates at 1 year, at 3 years and at the end of follow-up were 92%, 72% and 64%, respectively. There was significantly worse survival of patients with recurrent IE (log-rank test, P = 0.03). CONCLUSIONS Although the short-term results of operation for IE in IDUs are good, long-term outcomes are not satisfactory. The survival of patients with recurrence of IE caused by return to intravenous drug use is significantly worse.
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Affiliation(s)
- Vilem Rohn
- Department of Cardiovascular Surgery, 2nd Faculty of Medicine, Charles University in Prague, Motol University Hospital, Prague 5, Motol, Czech Republic
| | - Branislav Laca
- Department of Cardiovascular Surgery, 2nd Faculty of Medicine, Charles University in Prague, Motol University Hospital, Prague 5, Motol, Czech Republic
| | - Milan Horn
- Department of Cardiovascular Surgery, 2nd Faculty of Medicine, Charles University in Prague, Motol University Hospital, Prague 5, Motol, Czech Republic
| | - Lukas Vlk
- Department of Cardiovascular Surgery, 2nd Faculty of Medicine, Charles University in Prague, Motol University Hospital, Prague 5, Motol, Czech Republic
| | - Petra Antonova
- Department of Cardiovascular Surgery, 2nd Faculty of Medicine, Charles University in Prague, Motol University Hospital, Prague 5, Motol, Czech Republic
| | - Frantisek Mosna
- Department of Cardiovascular Surgery, 2nd Faculty of Medicine, Charles University in Prague, Motol University Hospital, Prague 5, Motol, Czech Republic
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Volk L, Verghis N, Chiricolo A, Ikegami H, Lee LY, Lemaire A. Early and intermediate outcomes for surgical management of infective endocarditis. J Cardiothorac Surg 2019; 14:211. [PMID: 31796074 PMCID: PMC6889706 DOI: 10.1186/s13019-019-1029-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 11/18/2019] [Indexed: 11/23/2022] Open
Abstract
Objective The treatment of active infective endocarditis (IE) presents a clinical dilemma with uncertain outcomes. This study sets out to determine the early and intermediate outcomes of patients treated surgically for active IE at an academic medical center. Methods A retrospective chart review was conducted to identify patients who underwent surgical intervention for IE at our institution from July 1st, 2011 to June 30th, 2018. In-patient records were examined to determine etiology of disease, surgical intervention type, postoperative complications, length of stay (LOS), 30-day in-hospital mortality, and 1-year survival. Results Twenty-five patients underwent surgical intervention for active IE. The average age of the patients was 47 ± 14 years old and most of the patients were male (N = 15). The majority of the patients had the mitral valve replaced (N = 10), with the remaining patients having tricuspid (N = 8) and aortic (N = 7) valve replacements. The etiology varied and included intravenous drug use (IVDU), and presence of transvenous catheters. The 30-day in-hospital mortality was 4% with 1 patient death and the 1-year survival was 80%. The average LOS was 27 days ±15 and the longest LOS was 65 days. Conclusions Surgical management of IE can be difficult and challenging however mortality can be minimized with acceptable morbidity. The most common complication was CVA. The average LOS is longer than traditional adult cardiac surgery procedures and the recurrence rate of valvular infection is not minimal especially if the underlying etiology is IVDU.
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Affiliation(s)
- Lindsay Volk
- Division of Cardiothoracic Surgery, Department of Surgery, RUTGERS-Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ, 08903, USA
| | - Nina Verghis
- Division of Cardiothoracic Surgery, Department of Surgery, RUTGERS-Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ, 08903, USA
| | - Antonio Chiricolo
- Division of Cardiothoracic Surgery, Department of Surgery, RUTGERS-Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ, 08903, USA
| | - Hirohisa Ikegami
- Division of Cardiothoracic Surgery, Department of Surgery, RUTGERS-Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ, 08903, USA
| | - Leonard Y Lee
- Division of Cardiothoracic Surgery, Department of Surgery, RUTGERS-Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ, 08903, USA
| | - Anthony Lemaire
- Division of Cardiothoracic Surgery, Department of Surgery, RUTGERS-Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ, 08903, USA.
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15
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Aithoussa M, Atmani N, Mounir R, Moutakiallah Y, Bamous M, Abdou A, Nya F, Seghrouchni A, Bellouize S, Drissi M, Elouennass M, Elbekkali Y, Boulahya A. Early results for active infective endocarditis. Pan Afr Med J 2018; 28:245. [PMID: 29881490 PMCID: PMC5989182 DOI: 10.11604/pamj.2017.28.245.13518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 10/21/2017] [Indexed: 11/26/2022] Open
Abstract
Introduction Cardiac surgery is frequently needed during active phase of infective endocarditis (IE). The purpose of this study was to analyze the immediate and late results and determine the risk factors for death. Methods We retrospectively reviewed 101 patients with IE operated in the active phase. The mean age was 40.5 ± 12.5 years. 16 patients (15.8%) were diagnosed with prosthetic valve endocarditis (PVE). 81 (80.9%) were in NYHA functional class III-IV. Blood cultures were positive in only 24 cases (23.9%). Results in-hospital mortality rate was 17.9% (18 cases). Multivariate analysis indentified five determinant predictor factors: congestive heart failure (CHF), renal insufficiency, high Euroscore, prolonged cardiopulmonary bypass time (> 120 min) and long ICU stay. The median follow-up period was 4.2 (2-6.5) years. Overall survival rate for all patients who survived surgery was 97% at 5 years and 91% at 10 years. Conclusion Despite high in-hospital mortality rate, when patients receive operation early in the active phase of their illness, late outcome may be good.
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Affiliation(s)
- Mahdi Aithoussa
- Department of Cardiovascular Surgery, Mohammed V Teaching Military Hospital, Hay Riad, 10100 Rabat, Morocco.,Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Souissi, Madinat Al Irfane, 10100 Rabat, Moroc
| | - Noureddine Atmani
- Department of Cardiovascular Surgery, Mohammed V Teaching Military Hospital, Hay Riad, 10100 Rabat, Morocco.,Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Souissi, Madinat Al Irfane, 10100 Rabat, Moroc
| | - Reda Mounir
- Department of Cardiovascular Surgery, Mohammed V Teaching Military Hospital, Hay Riad, 10100 Rabat, Morocco.,Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Souissi, Madinat Al Irfane, 10100 Rabat, Moroc
| | - Younes Moutakiallah
- Department of Cardiovascular Surgery, Mohammed V Teaching Military Hospital, Hay Riad, 10100 Rabat, Morocco.,Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Souissi, Madinat Al Irfane, 10100 Rabat, Moroc
| | - Mehdi Bamous
- Department of Cardiovascular Surgery, Mohammed V Teaching Military Hospital, Hay Riad, 10100 Rabat, Morocco.,Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Souissi, Madinat Al Irfane, 10100 Rabat, Moroc
| | - Abdessamad Abdou
- Department of Cardiovascular Surgery, Mohammed V Teaching Military Hospital, Hay Riad, 10100 Rabat, Morocco.,Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Souissi, Madinat Al Irfane, 10100 Rabat, Moroc
| | - Fouad Nya
- Department of Cardiovascular Surgery, Mohammed V Teaching Military Hospital, Hay Riad, 10100 Rabat, Morocco.,Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Souissi, Madinat Al Irfane, 10100 Rabat, Moroc
| | - Anis Seghrouchni
- Department of Cardiovascular Surgery, Mohammed V Teaching Military Hospital, Hay Riad, 10100 Rabat, Morocco.,Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Souissi, Madinat Al Irfane, 10100 Rabat, Moroc
| | - Siham Bellouize
- Department of Cardiovascular Surgery, Mohammed V Teaching Military Hospital, Hay Riad, 10100 Rabat, Morocco.,Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Souissi, Madinat Al Irfane, 10100 Rabat, Moroc
| | - Mohamed Drissi
- Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Souissi, Madinat Al Irfane, 10100 Rabat, Moroc.,Intensive Care of Cardiovascular Surgery, Mohammed V Teaching Military Hospital, Hay Riad, 10100 Rabat, Morocco
| | - Mostafa Elouennass
- Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Souissi, Madinat Al Irfane, 10100 Rabat, Moroc.,Department of Bacteriology, Mohammed V Teaching Military Hospital, Hay Riad, 10100 Rabat, Morocco
| | - Youssef Elbekkali
- Department of Cardiovascular Surgery, Mohammed V Teaching Military Hospital, Hay Riad, 10100 Rabat, Morocco.,Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Souissi, Madinat Al Irfane, 10100 Rabat, Moroc
| | - Abdelatif Boulahya
- Department of Cardiovascular Surgery, Mohammed V Teaching Military Hospital, Hay Riad, 10100 Rabat, Morocco.,Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Souissi, Madinat Al Irfane, 10100 Rabat, Moroc
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16
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A predictive model for early mortality after surgical treatment of heart valve or prosthesis infective endocarditis. The EndoSCORE. Int J Cardiol 2017; 241:97-102. [DOI: 10.1016/j.ijcard.2017.03.148] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 03/28/2017] [Indexed: 11/22/2022]
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17
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Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Fleisher LA, Jneid H, Mack MJ, McLeod CJ, O'Gara PT, Rigolin VH, Sundt TM, Thompson A. 2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2017; 135:e1159-e1195. [PMID: 28298458 DOI: 10.1161/cir.0000000000000503] [Citation(s) in RCA: 1392] [Impact Index Per Article: 198.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
| | | | - Robert O Bonow
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. SCAI Representative. STS Representative. ASE Representative. AATS Representative. SCA Representative
| | - Blase A Carabello
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. SCAI Representative. STS Representative. ASE Representative. AATS Representative. SCA Representative
| | - John P Erwin
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. SCAI Representative. STS Representative. ASE Representative. AATS Representative. SCA Representative
| | - Lee A Fleisher
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. SCAI Representative. STS Representative. ASE Representative. AATS Representative. SCA Representative
| | - Hani Jneid
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. SCAI Representative. STS Representative. ASE Representative. AATS Representative. SCA Representative
| | - Michael J Mack
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. SCAI Representative. STS Representative. ASE Representative. AATS Representative. SCA Representative
| | - Christopher J McLeod
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. SCAI Representative. STS Representative. ASE Representative. AATS Representative. SCA Representative
| | - Patrick T O'Gara
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. SCAI Representative. STS Representative. ASE Representative. AATS Representative. SCA Representative
| | - Vera H Rigolin
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. SCAI Representative. STS Representative. ASE Representative. AATS Representative. SCA Representative
| | - Thoralf M Sundt
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. SCAI Representative. STS Representative. ASE Representative. AATS Representative. SCA Representative
| | - Annemarie Thompson
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. SCAI Representative. STS Representative. ASE Representative. AATS Representative. SCA Representative
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18
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Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Fleisher LA, Jneid H, Mack MJ, McLeod CJ, O'Gara PT, Rigolin VH, Sundt TM, Thompson A. 2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2017; 70:252-289. [PMID: 28315732 DOI: 10.1016/j.jacc.2017.03.011] [Citation(s) in RCA: 1821] [Impact Index Per Article: 260.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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19
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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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20
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Lemaire A, Dombrovskiy V, Saadat S, Batsides G, Ghaly A, Spotnitz A, Lee LY. Patients with Infectious Endocarditis and Drug Dependence Have Worse Clinical Outcomes after Valvular Surgery. Surg Infect (Larchmt) 2017; 18:299-302. [PMID: 28099093 DOI: 10.1089/sur.2016.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Patients with infective endocarditis (IE) are at high risk for post-operative morbidity and death, which might be associated with drug abuse. The purpose of this study is to evaluate the impact of drug dependence on outcomes in patients who have IE and undergo valvular surgery (VS). PATIENTS AND METHODS The Nationwide/National Inpatient Sample 2001-2012 was queried to select patients with IE who had elective VS using International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis and procedure codes. Among them, patients with drug dependence (PDD) were identified, and their health status and post-operative outcomes were compared with those in patients without drug dependence (control group). Chi-square and Wilcoxon rank sum tests as well as multi-variable regression analysis were used for statistics. RESULTS A total of 809 (12.9%) PDD of the 6,264 patients who underwent VS were evaluated. They were younger compared with those in the control group (39.0 ± 10.8 y vs. 54.4 ± 14.8 y; p < 0.0001), had less age-related co-morbidities such as hypertension, diabetes mellitus, congestive heart failure, renal failure, obesity, but greater rates of alcohol abuse, liver disease, and psychoses. Despite the younger age and fewer co-morbidities, PDD compared with control patients were more likely to have post-operative complications develop overall (odds ratio [OR] = 1.6; 95% confidence interval [CI] 1.34-2.01), including infectious complications (OR = 1.5; 95% CI 1.27-1.78), specifically pneumonia (OR = 1.4; 95% CI 1.14-1.74) and sepsis (OR = 1.4; 95% CI 1.16-1.63), renal complications (OR = 1.5; 95% CI 1.23-1.77), and pulmonary embolism (OR = 1.9; 95% CI 1.44-2.52). Further, PDD had 11% longer hospital length of stay than those in the control groups (p < 0.0001). We did not find significant difference in hospital deaths, however, between these groups. CONCLUSION Drug dependence is associated with worse post-operative outcomes in patients with infective endocarditis who underwent valvular surgery and lengthens their hospital stay.
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Affiliation(s)
- Anthony Lemaire
- Department of Surgery, UMDNJ-Robert Wood Johnson Medical School , New Brunswick, New Jersey
| | - Viktor Dombrovskiy
- Department of Surgery, UMDNJ-Robert Wood Johnson Medical School , New Brunswick, New Jersey
| | - Siavash Saadat
- Department of Surgery, UMDNJ-Robert Wood Johnson Medical School , New Brunswick, New Jersey
| | - George Batsides
- Department of Surgery, UMDNJ-Robert Wood Johnson Medical School , New Brunswick, New Jersey
| | - Aziz Ghaly
- Department of Surgery, UMDNJ-Robert Wood Johnson Medical School , New Brunswick, New Jersey
| | - Alan Spotnitz
- Department of Surgery, UMDNJ-Robert Wood Johnson Medical School , New Brunswick, New Jersey
| | - Leonard Y Lee
- Department of Surgery, UMDNJ-Robert Wood Johnson Medical School , New Brunswick, New Jersey
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21
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Kanemitsu H, Nakamura K, Fukunaga N, Koyama T. Long-Term Outcomes of Mitral Valve Repair for Active Endocarditis. Circ J 2016; 80:1148-52. [DOI: 10.1253/circj.cj-15-1062] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hideo Kanemitsu
- Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital
| | - Ken Nakamura
- Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital
| | - Naoto Fukunaga
- Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital
| | - Tadaaki Koyama
- Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital
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22
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Sundaragiri PR, Vallabhajosyula S, Mahfood Haddad T, Esterbrooks DJ. Tricuspid and mitral endocarditis due to methicillin-resistant Staphylococcus aureus exhibiting vancomycin-creep phenomenon. BMJ Case Rep 2015; 2015:bcr2015211974. [PMID: 26531738 PMCID: PMC4654159 DOI: 10.1136/bcr-2015-211974] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2015] [Indexed: 11/04/2022] Open
Abstract
Right-sided infective endocarditis (RIE) is commonly due to Staphylococcus aureus and often involves the tricuspid valve (TV). A 31-year-old man with prior intravenous drug use presented with substernal pain, cough, dyspnoea and fever. Examination revealed a febrile, tachycardic male with peripheral infective endocarditis stigmata and right-heart failure. Laboratory parameters demonstrated leucocytosis, lactic acidosis and methicillin-resistant S. aureus (MRSA) bacteraemia. Echocardiography demonstrated multiple TV echodensities and chest imaging confirmed septic emboli. The MRSA species demonstrated 'vancomycin-creep', necessitating therapy with daptomycin and ceftaroline. Owing to persistent bacteraemia and septic shock, the patient underwent TV surgery, but continued to have a poor postoperative course with subsequent death. Indications for surgical therapy of RIE are limited to the European guidelines and most data are extrapolated from left-heart disease. MRSA exhibiting vancomycin-creep portends a poorer prognosis and requires aggressive therapy. We advocate the use of ceftaroline salvage therapy with daptomycin, pending further trials.
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Affiliation(s)
- Pranathi Rao Sundaragiri
- Division of Hospital Internal Medicine, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Saraschandra Vallabhajosyula
- Division of Critical Care Medicine, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Toufik Mahfood Haddad
- Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Dennis J Esterbrooks
- Division of Cardiovascular Diseases, Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA
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23
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Noyes AM, Ramu B, Parker MW, Underhill D, Gluck JA. Extracorporeal Membrane Oxygenation as a Bridge to Surgery for Infective Endocarditis Complicated by Aorto-Atrial Fistula and Cardiopulmonary Collapse. Tex Heart Inst J 2015; 42:471-3. [PMID: 26504445 DOI: 10.14503/thij-14-4575] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The timing of surgery for active infective endocarditis is challenging when patients exhibit mechanical dysfunction and hemodynamic compromise. Extracorporeal membrane oxygenation has been described in treating sepsis but not, insofar as we know, in treating the acute mechanical sequelae that arise from infective endocarditis. We report perhaps the first case that shows the usefulness of extracorporeal membrane oxygenation as a bridge to definitive treatment in a 35-year-old man who had infective endocarditis followed by aorto-atrial fistula and cardiopulmonary collapse.
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24
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Marks DJB, Hyams C, Koo CY, Pavlou M, Robbins J, Koo CS, Rodger G, Huggett JF, Yap J, Macrae MB, Swanton RH, Zumla AI, Miller RF. Clinical features, microbiology and surgical outcomes of infective endocarditis: a 13-year study from a UK tertiary cardiothoracic referral centre. QJM 2015; 108:219-29. [PMID: 25223570 DOI: 10.1093/qjmed/hcu188] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Infective endocarditis (IE) causes substantial morbidity and mortality. Patient and pathogen profiles, as well as microbiological and operative strategies, continue to evolve. The impact of these changes requires evaluation to inform optimum management and identify individuals at high risk of early mortality. AIM Identification of clinical and microbiological features, and surgical outcomes, among patients presenting to a UK tertiary cardiothoracic centre for surgical management of IE between 1998 and 2010. DESIGN Retrospective observational cohort study. METHODS Clinical, biochemical, microbiological and echocardiographic data were identified from clinical records. Principal outcomes were all-cause 28-day mortality and duration of post-operative admission. RESULTS Patients (n = 336) were predominantly male (75.0%); median age 52 years (IQR = 41-67). Most cases involved the aortic (56.0%) or mitral (53.9%) valves. Microbiological diagnoses, obtained in 288 (85.7%) patients, included streptococci (45.2%); staphylococci (34.5%); Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella (HACEK) organisms (3.0%); and fungi (1.8%); 11.3% had polymicrobial infection. Valve replacement in 308 (91.7%) patients included mechanical prostheses (69.8%), xenografts (24.0%) and homografts (6.2%). Early mortality was 12.2%, but fell progressively during the study (P = 0.02), as did median duration of post-operative admission (33.5 to 10.5 days; P = 0.0003). Multivariable analysis showed previous cardiothoracic surgery (OR = 3.85, P = 0.03), neutrophil count (OR = 2.27, P = 0.05), albumin (OR = 0.94, P = 0.04) and urea (OR = 2.63, P < 0.001) predicted early mortality. CONCLUSIONS This study demonstrates reduced post-operative early mortality and duration of hospital admission for IE patients over the past 13 years. Biomarkers (previous cardiothoracic surgery, neutrophil count, albumin and urea), predictive of early post-operative mortality, require prospective evaluation to refine algorithms, further improve outcomes and reduce healthcare costs associated with IE.
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Affiliation(s)
- D J B Marks
- From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK
| | - C Hyams
- From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK
| | - C Y Koo
- From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK
| | - M Pavlou
- From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK
| | - J Robbins
- From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK
| | - C S Koo
- From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK
| | - G Rodger
- From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK
| | - J F Huggett
- From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK
| | - J Yap
- From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK
| | - M B Macrae
- From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK
| | - R H Swanton
- From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK
| | - A I Zumla
- From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK
| | - R F Miller
- From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK
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Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA, O’Gara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM, Thomas JD, Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Creager MA, Curtis LH, DeMets D, Guyton RA, Hochman JS, Kovacs RJ, Ohman EM, Pressler SJ, Sellke FW, Shen WK, Stevenson WG, Yancy CW. 2014 AHA/ACC guideline for the management of patients with valvular heart disease. J Thorac Cardiovasc Surg 2014; 148:e1-e132. [DOI: 10.1016/j.jtcvs.2014.05.014] [Citation(s) in RCA: 631] [Impact Index Per Article: 63.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Martínez-Sellés M, Muñoz P, Arnáiz A, Moreno M, Gálvez J, Rodríguez-Roda J, de Alarcón A, García Cabrera E, Fariñas MC, Miró JM, Montejo M, Moreno A, Ruiz-Morales J, Goenaga MA, Bouza E. Valve surgery in active infective endocarditis: A simple score to predict in-hospital prognosis. Int J Cardiol 2014; 175:133-7. [DOI: 10.1016/j.ijcard.2014.04.266] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 04/29/2014] [Accepted: 04/30/2014] [Indexed: 10/25/2022]
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Thuny F, Grisoli D, Cautela J, Riberi A, Raoult D, Habib G. Infective endocarditis: prevention, diagnosis, and management. Can J Cardiol 2014; 30:1046-57. [PMID: 25151287 DOI: 10.1016/j.cjca.2014.03.042] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 03/27/2014] [Accepted: 03/28/2014] [Indexed: 12/22/2022] Open
Abstract
Infective endocarditis (IE) is among the most severe infectious disease, the prevention of which has not decreased its incidence. The age of patients and the rate of health care-associated IE have increased as a consequence of medical progress. The prevention strategies have been subjected to an important debate and nonspecific hygiene measures are now placed above the use of antibiotic prophylaxis. Indeed, the level of evidence of antibiotic prophylaxis efficiency is low and the indications of its prescription have been restricted in the recent international guidelines. In cases carrying a high suspicion of IE, efforts should be made to rapidly identify patients with a definite or highly probable diagnosis of IE and to find the causative pathogen to ensure that appropriate treatment, including urgent valvular surgery, begins promptly. Although echocardiography remains the main accurate imaging modality to identify endocardial lesions associated with IE, it can be negative or inconclusive especially in cases of prosthetic valve or other intracardiac devices. Recent studies demonstrated the diagnostic value of other imaging strategies including cardiac computed tomography (CT), positron emission tomography/CT, radiolabelled leukocyte single-photon emission CT/CT, and cerebral magnetic resonance imaging. Novel perspectives on the management of endocarditis are emerging and offer a hope for decreasing the rate of residual deaths by accelerating the processes of diagnosis, risk stratification, and instauration of antimicrobial therapy. Moreover, the rapid transfer of high-risk patients to specialized mediosurgical centres (IE team), the development of new surgical modalities, and close long-term follow-up are of crucial importance.
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Affiliation(s)
- Franck Thuny
- Département de Cardiologie, Unité Nord Insuffisance cardiaque et Valvulopathies (UNIV), Centre Hospitalier Universitaitre de Marseille, Hôpital Nord, Aix-Marseille Université, Marseille, France; Département de Cardiologie, Centre Hospitalier Universitaitre de Marseille, Hôpital de la Timone, Aix-Marseille Université, Marseille, France; URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, Faculté de Médecine, Aix-Marseille Université, Marseille, France.
| | - Dominique Grisoli
- Service de Chirurgie Cardiaque, Centre Hospitalier Universitaitre de Marseille, Hôpital de la Timone, Aix-Marseille Université, Marseille, France
| | - Jennifer Cautela
- Département de Cardiologie, Unité Nord Insuffisance cardiaque et Valvulopathies (UNIV), Centre Hospitalier Universitaitre de Marseille, Hôpital Nord, Aix-Marseille Université, Marseille, France; Département de Cardiologie, Centre Hospitalier Universitaitre de Marseille, Hôpital de la Timone, Aix-Marseille Université, Marseille, France
| | - Alberto Riberi
- Service de Chirurgie Cardiaque, Centre Hospitalier Universitaitre de Marseille, Hôpital de la Timone, Aix-Marseille Université, Marseille, France
| | - Didier Raoult
- URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, Faculté de Médecine, Aix-Marseille Université, Marseille, France
| | - Gilbert Habib
- Département de Cardiologie, Centre Hospitalier Universitaitre de Marseille, Hôpital de la Timone, Aix-Marseille Université, Marseille, France
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Weymann A, Borst T, Popov AF, Sabashnikov A, Bowles C, Schmack B, Veres G, Chaimow N, Simon AR, Karck M, Szabo G. Surgical treatment of infective endocarditis in active intravenous drug users: a justified procedure? J Cardiothorac Surg 2014; 9:58. [PMID: 24661344 PMCID: PMC3994393 DOI: 10.1186/1749-8090-9-58] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Accepted: 03/17/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Infective endocarditis is a life threatening complication of intravenous drug abuse, which continues to be a major burden with inadequately characterised long-term outcomes. We reviewed our institutional experience of surgical treatment of infective endocarditis in active intravenous drug abusers with the aim of identifying the determinants long-term outcome of this distinct subgroup of infective endocarditis patients. METHODS A total of 451 patients underwent surgery for infective endocarditis between January 1993 and July 2013 at the University Hospital of Heidelberg. Of these patients, 20 (7 female, mean age 35 ± 7.7 years) underwent surgery for infective endocarditis with a history of active intravenous drug abuse. Mean follow-up was 2504 ± 1842 days. RESULTS Staphylococcus aureus was the most common pathogen detected in preoperative blood cultures. Two patients (10%) died before postoperative day 30. Survival at 1, 5 and 10 years was 90%, 85% and 85%, respectively. Freedom from reoperation was 100%. Higher NYHA functional class, higher EuroSCORE II, HIV infection, longer operating time, postoperative fever and higher requirement for red blood cell transfusion were associated with 90-day mortality. CONCLUSIONS In active intravenous drug abusers, surgical treatment for infective endocarditis should be performed as extensively as possible and be followed by an aggressive postoperative antibiotic therapy to avoid high mortality. Early surgical intervention is advisable in patients with precipitous cardiac deterioration and under conditions of staphylococcal endocarditis. However, larger studies are necessary to confirm our preliminary results.
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Affiliation(s)
- Alexander Weymann
- Department of Cardiac Surgery, Heart and Marfan Center, University Hospital of Heidelberg, Im Neuenheimer Feld 110, Heidelberg 69120, Germany
- Department of Cardiothoracic Transplantation & Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Hill End Road, Harefield, Middlesex, London UB9 6JH, UK
| | - Tobias Borst
- Pharmacy Department, University Hospital of Heidelberg, INF 670, Heidelberg 69120, Germany
| | - Aron-Frederik Popov
- Department of Thoracic and Cardiovascular Surgery, University Hospital Göttingen, Robert-Koch-Straße 40, Göttingen 37075, Germany
| | - Anton Sabashnikov
- Department of Cardiothoracic Transplantation & Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Hill End Road, Harefield, Middlesex, London UB9 6JH, UK
| | - Christopher Bowles
- Department of Cardiothoracic Transplantation & Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Hill End Road, Harefield, Middlesex, London UB9 6JH, UK
| | - Bastian Schmack
- Department of Cardiac Surgery, Heart and Marfan Center, University Hospital of Heidelberg, Im Neuenheimer Feld 110, Heidelberg 69120, Germany
| | - Gabor Veres
- Department of Cardiac Surgery, Heart and Marfan Center, University Hospital of Heidelberg, Im Neuenheimer Feld 110, Heidelberg 69120, Germany
| | - Nicole Chaimow
- Department of Cardiac Surgery, Heart and Marfan Center, University Hospital of Heidelberg, Im Neuenheimer Feld 110, Heidelberg 69120, Germany
| | - Andre Rüdiger Simon
- Department of Cardiothoracic Transplantation & Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Hill End Road, Harefield, Middlesex, London UB9 6JH, UK
| | - Matthias Karck
- Department of Cardiac Surgery, Heart and Marfan Center, University Hospital of Heidelberg, Im Neuenheimer Feld 110, Heidelberg 69120, Germany
| | - Gábor Szabo
- Department of Cardiac Surgery, Heart and Marfan Center, University Hospital of Heidelberg, Im Neuenheimer Feld 110, Heidelberg 69120, Germany
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Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA, O'Gara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM, Thomas JD. 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014; 129:2440-92. [PMID: 24589852 DOI: 10.1161/cir.0000000000000029] [Citation(s) in RCA: 1015] [Impact Index Per Article: 101.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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30
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Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA, O'Gara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM, Thomas JD. 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014; 129:e521-643. [PMID: 24589853 DOI: 10.1161/cir.0000000000000031] [Citation(s) in RCA: 867] [Impact Index Per Article: 86.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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31
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Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA, O'Gara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM, Thomas JD. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014; 63:2438-88. [PMID: 24603191 DOI: 10.1016/j.jacc.2014.02.537] [Citation(s) in RCA: 1338] [Impact Index Per Article: 133.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Abstract
Infective endocarditis is a serious disease of the endocardium of the heart and cardiac valves, caused by a variety of infectious agents, ranging from streptococci to rickettsia. The proportion of cases associated with rheumatic valvulopathy and dental surgery has decreased in recent years, while endocarditis associated with intravenous drug abuse, prosthetic valves, degenerative valve disease, implanted cardiac devices, and iatrogenic or nosocomial infections has emerged. Endocarditis causes constitutional, cardiac and multiorgan symptoms and signs. The central nervous system can be affected in the form of meningitis, cerebritis, encephalopathy, seizures, brain abscess, ischemic embolic stroke, mycotic aneurysm, and subarachnoid or intracerebral hemorrhage. Stroke in endocarditis is an ominous prognostic sign. Treatment of endocarditis includes prolonged appropriate antimicrobial therapy and in selected cases, cardiac surgery. In ischemic stroke associated with infective endocarditis there is no indication to start antithrombotic drugs. In previously anticoagulated patients with an ischemic stroke, oral anticoagulants should be replaced by unfractionated heparin, while in intracranial hemorrhage, all anticoagulation should be interrupted. The majority of unruptured mycotic aneurysms can be treated by antibiotics, but for ruptured aneurysms, endovascular or neurosurgical therapy is indicated.
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Affiliation(s)
- José M Ferro
- Department of Neurosciences, Serviço de Neurologia, Hospital de Santa Maria, University of Lisbon, Lisbon, Portugal.
| | - Ana Catarina Fonseca
- Department of Neurosciences, Serviço de Neurologia, Hospital de Santa Maria, University of Lisbon, Lisbon, Portugal
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33
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Impact of antimicrobial therapy on prognosis of patients requiring valve surgery during active infective endocarditis. J Thorac Cardiovasc Surg 2014; 147:254-8. [DOI: 10.1016/j.jtcvs.2012.10.019] [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: 08/13/2012] [Revised: 09/14/2012] [Accepted: 10/10/2012] [Indexed: 11/21/2022]
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Keane C, Petersen HJ, Tilley D, Haworth J, Cox D, Jenkinson HF, Kerrigan SW. Multiple sites on Streptococcus gordonii surface protein PadA bind to platelet GPIIbIIIa. Thromb Haemost 2013; 110:1278-1287. [PMID: 24136582 DOI: 10.1160/th13-07-0580] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 08/12/2013] [Indexed: 11/05/2022]
Abstract
Infective endocarditis is a life threatening disease caused by a bacterial infection of the endocardial surfaces of the heart. The oral pathogen, Streptococcus gordonii is amongst the most common pathogens isolated from infective endocarditis patients. Previously we identified a novel cell wall protein expressed on S. gordonii called platelet adherence protein A (PadA) that specifically interacts with platelet GPIIb/IIIa. The interaction between PadA and GPIIb/IIIa resulted in firm platelet adhesion, dense granule secretion and platelet spreading on immobilised S. gordonii. This study set out to identify specific motifs on the PadA protein that interacts with platelet GPIIb/IIIa. Proteomic analysis of the PadA protein identified two short amino acid motifs which have been previously shown to be important for fibrinogen binding to GPIIb/IIIa and contributing to the generation of outside-in signalling. Site directed mutagenesis on the PadA protein in which ₄₅₄AGD was substituted to AAA, and the ₃₈₃RGT was substituted to AAA suggests the RGT motif has no role in supporting platelet adhesion however plays a role in dense granule secretion and platelet spreading. In contrast to this the AGD motif has no role to play in supporting firm platelet adhesion or dense granule secretion however plays a role in platelet spreading. These results suggest that multiple sites on S. gordonii PadA interact with GPIIb/IIIa to mediate a number of platelet responses that likely contribute to the thrombotic complications of infective endocarditis.
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Affiliation(s)
- Ciara Keane
- Cardiovascular Infection Group, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Helen J Petersen
- School of Oral and Dental Sciences, University of Bristol, Lower Maudlin Street, Bristol BS12LY, England
| | - Dorothea Tilley
- Cardiovascular Infection Group, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Jennifer Haworth
- School of Oral and Dental Sciences, University of Bristol, Lower Maudlin Street, Bristol BS12LY, England
| | - Dermot Cox
- Cardiovascular Infection Group, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Howard F Jenkinson
- School of Oral and Dental Sciences, University of Bristol, Lower Maudlin Street, Bristol BS12LY, England
| | - Steve W Kerrigan
- Cardiovascular Infection Group, Royal College of Surgeons in Ireland, Dublin 2, Ireland
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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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36
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Sedgwick JF, Burstow DJ. Update on echocardiography in the management of infective endocarditis. Curr Infect Dis Rep 2012; 14:373-80. [PMID: 22544484 DOI: 10.1007/s11908-012-0262-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Echocardiography is the major imaging modality used for the diagnosis of infective endocarditis (IE). It is also useful in detecting the complications of IE which often necessitate surgical intervention and strongly influence patient outcomes. Transesophageal echocardiography (TEE), with proven superiority over transthoracic echocardiography (TTE) for the detection of vegetations and complications such as abscess, should be performed in the vast majority of cases especially when TTE image quality is poor or implanted devices are present. Three-dimensional (3D) TEE provides enhanced display of anatomic-spatial relationships allowing more precise delineation of complex pathology, particularly of the mitral valve and annulus. Importantly, echocardiographic findings can be non-specific and should always be interpreted in the context of the pre-test probability of IE based on careful clinical assessment. IE remains a challenging disease associated with variable clinical presentations, and high mortality. Whenever IE is suspected, echocardiography should be utilized early for both diagnosis and detection of complications.
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Manne MB, Shrestha NK, Lytle BW, Nowicki ER, Blackstone E, Gordon SM, Pettersson G, Fraser TG. Outcomes after surgical treatment of native and prosthetic valve infective endocarditis. Ann Thorac Surg 2012; 93:489-93. [PMID: 22206953 DOI: 10.1016/j.athoracsur.2011.10.063] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2011] [Revised: 10/19/2011] [Accepted: 10/25/2011] [Indexed: 11/25/2022]
Abstract
BACKGROUND The risk of death and complications of infective endocarditis (IE) treated medically has to be balanced against those from surgery in constructing a therapeutic approach. Recent literature has drawn conflicting conclusions on the benefit of surgery for IE. We reviewed patients treated surgically for IE at the Cleveland Clinic from 2003 to 2007 to examine their outcomes. METHODS A retrospective review of consecutive patients who underwent surgery for native and prosthetic valve endocarditis between January 1, 2003, and December 31, 2007, was conducted. Surgical outcomes were reviewed to include survival and postoperative complications. Survival was evaluated at end of hospital stay, 30 days, 1 year, and at last follow-up. RESULTS Four hundred twenty-eight patients underwent surgery for IE during the study period: 248 (58%) had native valve endocarditis and 180 (42%) had prosthetic valve endocarditis. Overall 90% of patients survived to hospital discharge. When compared with patients with native valve infection, patients with prosthetic infection had significantly higher 30-day mortality (13% versus 5.6%; p<0.01), but long-term survival was not significantly different (35% versus 29%; p=0.19). Patients with IE caused by Staphylococcus aureus had significantly higher hospital mortality (15% versus 8.4%; p<0.05), 6-month mortality (23% versus 15%; p=0.05), and 1-year mortality (28% versus 18%; p=0.02) compared with non-S aureus IE. CONCLUSIONS Surgical treatment of IE was associated with 90% hospital survival. Outcomes within the 30 days were better for native valve than for prosthetic valve endocarditis. Long-term outcomes were similar. Finally, S aureus was associated with significantly higher mortality compared with other pathogens.
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Affiliation(s)
- Mahesh B Manne
- Department of Internal Medicine, Medicine Institute, The Cleveland Clinic, Cleveland, Ohio 44195, USA.
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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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41
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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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Influence of preoperative antibiotherapy on valve culture results and outcome of endocarditis requiring surgery. J Infect 2009; 59:42-8. [DOI: 10.1016/j.jinf.2009.04.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2008] [Revised: 03/25/2009] [Accepted: 04/27/2009] [Indexed: 12/20/2022]
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Surgical management for active infective endocarditis: A single hospital 10 years experience. Indian J Thorac Cardiovasc Surg 2008. [DOI: 10.1007/s12055-008-0016-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Delmo Walter EM, Musci M, Nagdyman N, Hübler M, Berger F, Hetzer R. Mitral Valve Repair for Infective Endocarditis in Children. Ann Thorac Surg 2007; 84:2059-65. [DOI: 10.1016/j.athoracsur.2007.07.038] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2007] [Revised: 07/11/2007] [Accepted: 07/12/2007] [Indexed: 10/22/2022]
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Colli A, Campodonico R, Gherli T. Early switch from vancomycin to oral linezolid for treatment of gram-positive heart valve endocarditis. Ann Thorac Surg 2007; 84:87-91. [PMID: 17588391 DOI: 10.1016/j.athoracsur.2007.02.096] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2006] [Revised: 02/23/2007] [Accepted: 02/26/2007] [Indexed: 01/02/2023]
Abstract
BACKGROUND Patients with complicated gram-positive endocarditis are usually treated with a combination of surgical procedure and long-term antibiotic therapy with intravenous vancomycin. However, oral linezolid offers the potential for an early switch from intravenous vancomycin to oral linezolid therapy. METHODS We conducted a retrospective study from February 2002 to August 2005 to determine the potential for early switch from intravenous vancomycin to oral linezolid in patients surgically treated for a left-sided active gram-positive endocarditis. RESULTS Fourteen patients were identified; average age was 52 +/- 16 years. There were 10 (85%) and 2 (15%) cases of native and prosthetic valve endocarditis, respectively. Patients were operated on 3 to 10 days after diagnosis. There were no cases of operative mortality. Mean follow-up was 20.8 +/- 7.0 months. Two (14%) patients died of noncardiac causes during follow-up. The mean intensive care unit length of stay was 3.1 +/- 2.3 days, and mean hospital length of stay was 10.5 +/- 3.4 days. No cases of recurrent endocarditis or periprosthetic leakage were observed. CONCLUSIONS The combination of aggressive surgical treatment and the early switch from intravenous vancomycin to oral linezolid for treatment of active gram-positive heart valve endocarditis is safe and effective, and reduces infection relapses, vancomycin use, hospital length of stay, and economic costs.
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Affiliation(s)
- Andrea Colli
- Department of Cardiac Surgery, University of Parma, Parma, Italy.
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Bendriss L, Bekkali Y, Mrani S, Chaib A, Wahid FA, Berrada N, Benyass A, Kendoussi M, Boulahya A, Kirat A. [Early surgery in infective endocarditis. Retrospective study apropos of 30 cases]. Ann Cardiol Angeiol (Paris) 2007; 56:111-6. [PMID: 17572170 DOI: 10.1016/j.ancard.2007.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2006] [Accepted: 02/19/2007] [Indexed: 11/27/2022]
Abstract
AIM The aim of this study is to stress the interest of the early surgery in infective endocarditis (IE), its indications and prognostic implications. METHODS It is a retrospective descriptive study of 30 cases (29 men and 1 woman with an average age of 35+/-12 years) with IE underwent surgery management in the acute phase between September 1993 and June 2005. RESULTS They were 25 rheumatic lesions, 2 aortic bicuspids and 3 mechanical valves prosthesis. Four twenty-six percent of the patients were operated for hemodynamic deterioration and 10% for embolic complication. We report 3 cases (that is to say 10%) of IE late form on prosthesis. Three patients died in the first post operative month by respectively total desinsertion of mitral prosthesis on peroperative, 1 septic shock at the 13th post operative day and 1 tamponade at the 14th postoperative day. On 72 months an average follow-up, 26 were controlled regularly: 25 evolved favourably and 1 died in third postoperative year (severe heart failure). CONCLUSION A high early surgery rate is related to good long term results and does not increase in hospital mortality. The reduced mortality was particularly evident among patients with moderate to severe congestive heart failure.
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Affiliation(s)
- L Bendriss
- Service de cardiologie, HMIMV, Rabat, Maroc.
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Kamalakannan D, Pai RM, Johnson LB, Gardin JM, Saravolatz LD. Epidemiology and clinical outcomes of infective endocarditis in hemodialysis patients. Ann Thorac Surg 2007; 83:2081-6. [PMID: 17532401 DOI: 10.1016/j.athoracsur.2007.02.033] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2006] [Revised: 02/08/2007] [Accepted: 02/14/2007] [Indexed: 11/17/2022]
Abstract
BACKGROUND Infective endocarditis is one of the most serious complications of bacteremia in patients undergoing chronic hemodialysis and is more frequent than previously recognized. The aim of our study was to describe the clinical characteristics, outcome, and factors predicting mortality of infective endocarditis in hemodialysis patients. METHODS In this retrospective review, all patients on chronic hemodialysis admitted to a 600-bed urban teaching hospital with infective endocarditis over a 15-year period (1990 to 2004), were identified using discharge codes. Modified Duke criteria were retrospectively applied, and patients fulfilling the criteria for definite endocarditis were included in the study. RESULTS Sixty-nine patients on hemodialysis with definite endocarditis were identified. The predominant type of vascular access was double-lumen catheter (66.7%). The mean duration of dialysis was 37 +/- 32 months. The predominant organism was Staphylococcus aureus (57.9%), of which 57.5% were methicillin susceptible. The most frequently infected valve was mitral (49.3%), followed by aortic (21.7%) and tricuspid (10.1%) valves. The cardiac and neurologic complication rates were 40.6% and 37.7%, respectively. Fifteen patients underwent valvular heart surgery. The overall in-hospital mortality was 49.3% (34 of 69). More patients who had surgery survived than patients who did not (12 of 15 versus 23 of 54; p = 0.018, odds ratio = 5.39, 95% confidence interval: 1.3 to 17.6). On logistic regression, valve surgery was the only independent factor predicting survival (p = 0.023). CONCLUSIONS The prognosis of infective endocarditis in hemodialysis patients is poor, with surgery serving as an independent predictor of survival.
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Affiliation(s)
- Desikan Kamalakannan
- St. John Hospital and Medical Center, Wayne State University School of Medicine, Detroit, Michigan 48236, USA.
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de Kerchove L, Vanoverschelde JL, Poncelet A, Glineur D, Rubay J, Zech F, Noirhomme P, El Khoury G. Reconstructive surgery in active mitral valve endocarditis: feasibility, safety and durability. Eur J Cardiothorac Surg 2007; 31:592-9. [PMID: 17270457 DOI: 10.1016/j.ejcts.2007.01.002] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2006] [Revised: 12/19/2006] [Accepted: 01/04/2007] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE To evaluate timing for surgery and management of complex valve lesions in patients with active mitral valve (MV) endocarditis. Results are based on 13 years of experience with MV repair in active endocarditis. METHOD Between 1993 and 2005, 81 patients were operated for active MV endocarditis, of which 63 (or 78%) had MV repair. For all patients, the median time between diagnosis and surgery was 10 days. Diverse surgical techniques were applied to restore MV competence. In 59% of the patients, pericardial patches, tricuspid autograft or partial MV homografts were used as leaflet substitutes. In addition, prosthetic rings were employed in 44% of the patients. RESULTS The overall operative mortality was 17.5%. However, considering only patients in preoperative NYHA class I or II, the operative mortality could be reduced to 4.8%. NYHA class > or =3, elevated age (above 70 years) and history of valvular were the three independent risks factors for early mortality in our multivariate analysis. The average follow-up time was 60+/-37 months. During this period, five late deaths occurred, two of which were cardiac-related. The overall 5- and 10-year survival rate was 73+/-12% and 69+/-13%, respectively. In hospital survivors, freedom from cardiac death after 5 and 10 years was 93+/-8%. Three early and five late MV reoperations occurred in seven patients, of them four could have MV re-repair. Only one endocarditis recurrence occurred after 4 months in a chronic haeamodialysed patient. Freedom from MV reoperation was 89+/-10% and 72+/-24% at 5 and 10 years, respectively. Ten-year freedom from MV replacement and from endocarditis recurrence were 95+/-5% and 98+/-1%, respectively. Annular abscesses and calcified or rheumatic MV disease were two independent risk factors associated with reoperation in our multivariate analysis. During the follow-up period, all patients were in NYHA class I or II; 89% of patients had mitral regurgitation grade < or =I, only 11% had grade II on transthoracic echocardiography. CONCLUSION Using diverse and advanced techniques of MV repair, a reparability rate of 80% can be reached among patients with active endocarditis. We demonstrate that a high level of safety and excellent durability of MV repair can be obtained even for complex repairs.
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Affiliation(s)
- Laurent de Kerchove
- Division of Cardiothoracic and Vascular Surgery, Université Catholique de Louvain, Brussels, Belgium.
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Prevention and Treatment of Endocarditis. Cardiovasc Ther 2007. [DOI: 10.1016/b978-1-4160-3358-5.50050-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Baumgartner FJ, Milliken JC, Robertson JM, Stein AG, Scott RP, Milliken JC, Omari BO. Clinical Patterns of Surgical Endocarditis. J Card Surg 2007; 22:32-8. [PMID: 17239208 DOI: 10.1111/j.1540-8191.2007.00334.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study was aimed at defining clinical and anatomic patterns in cases of surgical endocarditis (SE). METHODS SE cases done between 1981 and 1997 at our metropolitan county hospital were retrospectively analyzed. RESULTS A total of 106 consecutive episodes of SE involving 125 valves in 100 patients were studied. SE included 71 aortic, 42 mitral, and 12 tricuspid valves. The etiologies included intravenous drug abuse (IVDA) in 48 (45%) and dental source in 30 (28%). A congenitally deformed valve was present in 19 (18%). Compared to non-IVDA, IVDA episodes of SE were more often superimposed on previously normal valves (38/48 [79%] vs. 30/58 [52%])**, S. aureus infections (17/43 [40%] vs. 9/54 [17%])*, active endocarditis (38/48 [79%] vs. 32/58 [55%])*, and surgically treated on an urgent basis (10/48 [21%] vs. 4/58 [7%])*. Overall, macroemboli occurred in 53 (50%) of SE and was associated with pseudoaneurysm*, preoperative neurologic dysfunction,** and operative death.** The operative mortality (defined by Society of Thoracic Surgeons) for SE was 5/106 (4.7%). Macroembolism,** aortoventricular discontinuity,** abscesses,* pseudoaneurysm,** and preoperative renal failure* were associated with mortality. Prosthetic valve endocarditis was present in 10 of 106 episodes of SE (9.4%). *p < or = 0.05; **p < or = 0.01. CONCLUSION (1) The aortic valve is most commonly associated with SE, (2) SE of a previously normal valve is more likely to occur with IVDA than other etiologies, (3) macroemboli occur in half of SE and is associated with an increased operative mortality.
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