Valve Infection Research Articles

RETRACTED: Real time monitoring of medical images and nursing intervention after heart valve replacement

Heart valve surgery is a leak reduction or repair operation or replacement of the infected valve. To alleviate the symptoms of valvular heart disease, it can prevent permanent damage to the heart. Heart valve surgery is normally open-heart surgery. This means cutting the sternum and to reach the heart. However, in response to the problems and other factors, there may be a procedure of other alternatives. Echocardiography and fluoroscopy is the main technique used for evaluation of the Prosthetic Heart Valve (PHV), for a particular cause restriction, they are the degree of morphological substrate or PHV pathology it cannot identify. Cardiac computed tomography or magnetic resonance imaging has become the new imaging modalities for the valve prosthesis. It propose the possibility of a systematic literature review based on all of the experiments and the patient's study. Pitfalls of Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) provide an overview of the evaluation of the PHV. Metal artifacts might interfere with prosthetics analyzed directly in the MRI, provides information about the flow pattern and velocity associated with PHV. MRI shows an abnormal, asymmetric flow pattern of PHV barriers, enables the evaluation of repair reflux. Therefore, it offers great clinical relevance as a complementary imaging tool for diagnosing CT suspected PHV disorders and endocarditis. MRI is more research to enable a normal identification from pathological conditions required to provide a diagnostic reference value, to be used for functional PHV evaluation potential shows.

Active mitral valve endocarditis with widespread interventricular septal abscesses in a paediatric patient

We present the case of a previously healthy 2-year-old boy with extensive infective mitral valve endocarditis, with 2 huge, mobile vegetations attached to the anterior leaflet of the mitral valve and to the left ventricular outflow tract, and interventricular septal abscesses extending into the left ventricular outflow tract without any septal defects. He underwent mitral valve repair and simultaneous drainage of the interventricular septal abscesses excluding the inlet portion to avoid postoperative complications.

Massa Valvar Mitral em Paciente com Suspeita de Lúpus Sistêmico: Tumor, Endocardite ou Ambos?

ResumoApresentamos o relato de caso de uma paciente com mixoma valvar mitral infectado e uma revisão da literatura sobre o assunto. Uma mulher de 33 anos apresentou histórico de febre e dispneia com evolução de alguns dias. Na hospitalização, ela apresentava uma síndrome semelhante ao lúpus, com hemoculturas positivas para Haemophilus spp . O ecocardiograma revelou uma massa gigante envolvendo ambos os folhetos mitrais associada à regurgitação grave, necessitando de troca valvar mitral biológica. A microscopia revelou mixoma infectado e a paciente recebeu alta assintomática após o término da antibioticoterapia. Ela apresentou bons resultados no seguimento. Este é o sexto caso de mixoma valvar mitral infectado relatado na literatura e o terceiro caso de mixoma cardíaco infectado pelo grupo HACEK. Devido à alta incidência de eventos embólicos, a antibioticoterapia precoce aliada à pronta intervenção cirúrgica são decisivos para a redução da morbimortalidade. O tempo para o diagnóstico foi muito mais breve do que o geralmente relatado em casos de endocardite por HACEK. A troca valvar foi a intervenção mais comum e todos os pacientes em relatos de caso anteriores apresentaram bons resultados no seguimento.

Sharing of decision-making for infective endocarditis surgery: a narrative review of clinical and ethical implications.

Infective endocarditis (IE) is nowadays one of the most challenging disease in cardiac surgery because of its multifaceted clinical and anatomical presentation. Despite the many clinical and surgical advances achieved in the past 60 years, there is a lack of evidence regarding the ideal strategy. The present review aims to investigate and highlight two main novel concepts for the decision-making of the best substitute. Firstly, the concept of an “endocarditis team”: a coordinated multidisciplinary effort in the diagnostic work-up, especially in conditions of high risk of embolization or clinical deterioration. A good “endocarditis team” has the role to overcome such problem, in order to ensure a prompt and balanced strategy. Secondly, which ethical considerations are required to drive the choice of valvular substitute. The choice of best valve substitute is a relevant issue of debate, not only with operative but also prognostic and accordingly ethical aftermaths. Many different solutions have been developed to substitute the infected valve. Among these: mechanical prosthesis (MP), biological stented prosthesis (BP), sutureless bioprosthesis and cryopreserved homografts (CHs). Patients need to be informed in detail about the technical issues pertaining the use of these valve substitute. We will discuss the evidences regarding the risk of recurrent infections or future potentially severe calcification of aortic homograft valve and wall (in other words, the failure of the homograft) and the difficulties in managing the reoperation.

Outcomes of patients with acute prosthetic aortic valve endocarditis.

Prosthetic valve endocarditis is burdened by high mortality and morbidity. We reviewed our experience in the management of patients with acute prosthetic aortic valve infection and studied the implications and outcomes associated with surgical treatment and medical therapy. Data of 118 consecutive patients admitted during the period 2008-2018 with definite acute prosthetic aortic valve endocarditis, and presenting a surgical indication, were retrieved from the hospital database. Univariate and multivariate analysis were undertaken to study the association of preoperative characteristics with hospital mortality and the probability of undergoing a reoperation. Survival was assessed with Kaplan-Meier analysis. In the overall population, prosthesis dehiscence was independently associated with the possibility of undergoing surgical reoperation, while presentation with embolic stroke was associated with medical treatment. Hospital mortality was 24%, medical treatment was found to be independently associated with early death. One hundred (85%) patients underwent redo procedures; aortic valve replacement was performed in 53 and full root replacement in 47. Postoperative hospital mortality was 17%. Survival at 1-, 5-, and 8-years was 78%, 74%, and 66%, respectively. Freedom from reoperation and recurrent endocarditis was 95% at 8-year follow-up.Hospital mortality in patients who did not receive a redo operation was 61% with a survival rate of 17% at 1-year follow-up. Surgical mortality after reoperation for prosthetic aortic valve endocarditis is still high but mid-term outcomes are satisfactory. Failure to undertake surgery when indicated is an independent risk factor for early death.

Diagnosis and management of coronary artery disease in early surgical treatment of acute infective endocarditis of the aortic valve

Abstract Background The need to routinely screen for coronary artery disease (CAD) in asymptomatic patients undergoing surgery for acute aortic valve infective endocarditis (IE) is debated. There is concern about the risk of embolization during invasive coronary angiography (ICA), especially in patients with vegetations. Coronary computed tomography angiography (cCTA) is a non-invasive alternative. Purpose To evaluate the prevalence of CAD in patients with acute aortic valve IE, the safety and feasibility of ICA and cCTA for diagnosis of CAD, and CAD related postoperative outcomes. Methods In this single center retrospective cohort study, all patients with acute infective aortic valve endocarditis between 2009–2019 undergoing surgery were selected. Outcomes were embolization after preoperative ICA, in-hospital mortality, perioperative myocardial infarction or unplanned revascularization. Results 159 patients (mean age 58±15, 81% male) underwent surgery. No CAD screening was done in 46/145, a cCTA was performed in 54/145 patients and an ICA in 52/145 patients. In 1 of the 52 patients undergoing preoperative ICA a cerebral embolism occurred. cCTA was not assessable on a patient level in 2 patients and 7 patients underwent both cCTA and ICA. Significant CAD was found in about 20% of patients both after cCTA and ICA. Even though just a minority of patients with CAD was treated with concomitant CABG, only 1 patient with known but untreated CAD needed unplanned revascularization postoperatively. The rate of perioperative myocardial infarction or unplanned revascularization in patients not screened for CAD was 5% (3 patients). Conclusion In patients with acute aortic valve IE the prevalence of CAD is low (14%). The risk of embolism after preoperative ICA is not negligible and should be carefully weighed against the estimated risk of CAD-related perioperative complications. cCTA might serve as a gatekeeper for ICA in many patients with acute aortic IE. Funding Acknowledgement Type of funding source: None

Qualitative and semiquantitative [18F]FDG-PET/CT analysis in patients with IE: a strategy to enhance specificity?

Abstract Aim The 2015 ESC Guideline for the diagnosis and management of infectious endocarditis (IE) included molecular imaging procedures such as radiolabeled leukocytes and [18F]FDG-PET/CT as major criteria to establish the diagnosis of IE. Whereas in case of radiolabeled leukocytes the criteria for defining positive and negative scan are well established, in case of [18F]FDG-PET/CT a consensus of the criteria that define a positive scan is still lacking. Materials and methods In this work we prospectively evaluated a series of 90 patients (M:F=60:30, mean age 67±16 years, median age 72 years, range 18–88) that performed [18F]FDG-PET/CT for suspected IE between January 2016 and January 2019 in our center to define which pattern of uptake and semiquantitative parameters (SUVmax, SUVmean, valve/liver, valve/lung and valve/mediastinum uptake ratio) present the highest diagnostic accuracy for IE. PET/CT results were correlated with transthoracic (TTE) or transesophageal (TEE) echocardiography, blood culture, the Duke criteria. The new ESC criteria were also evaluated. Results Globally PET/CT presented sensitivity=96% and specificity=75%, NPV= 97% and PPV=68%. A focal pattern of uptake was found 17/30 patients with confirmed IE (mean SUVmax=5.29±1.8, median SUVmax=5.5) whereas whereas a diffuse pattern of uptake was found in 11 patients with confirmed IE (mean SUVmax=8.1±3.5, median SUVmax=7.6). No significant differences between the valve/liver ratio uptake and the valve/mediastinum uptake ratio were found between positive and negative patients with either focal or diffuse pattern of uptake. Interesting, in presence of diffuse valve uptake both SUVmax and the valve/lung uptake ratio were significantly higher in patients with a final diagnosis of IE, including the group of patients under antimicrobial treatment (>90%). PET/CT confirmed its ability to identify extracardiac sites of [18F]FDG uptake in presence of septic embolism (35%) and in patients with other diseases (vasculitis, vascular prosthesis infections, mediastinitis and cancer, particularly in patients with IE sustained by Streptococcus Gallolyticus). Conclusions Our results suggest pattern of [18F]FDG uptake more specific for valve infection is a focal uptake or a diffuse uptake with a SUVmax>5 and a valve/lung ratio >8. Funding Acknowledgement Type of funding source: None

Early bioprosthesis failure in mitral valve replacement.

The causes of early bioprosthesis failure include infective endocarditis, pannus formation, and structural valve deterioration. We reported a patient who suffered from early mitral bioprosthesis failure due to leaflets restricted by the subvalvular apparatus and early pannus formation. In patients with symptoms relapse and mitral regurgitation recurrence early after mitral valve replacement, early pannus formation needs to be anticipated, and surgical intervention should be performed if symptoms persist after medical treatment.

Transcatheter and surgical aortic valve replacement impact on outcomes and cancer treatment schedule

Background.Recent data suggest that transcatheter aortic valve replacement (TAVR) for the treatment of severe aortic stenosis (AS) is viable in cancer patients. TAVR may be preferred in cancer patients due to its minimally invasive nature and smaller impact on oncologic therapies compared to SAVR.ObjectivesWe sought to determine if TAVR is an acceptable alternative to SAVR in cancer patients and whether TAVR allows for earlier initiation or resumption of anti-cancer therapies.Methods.Cancer patients in a tertiary cancer center diagnosed with severe AS were retrospectively included. Patients accepted by the heart team underwent either TAVR or SAVR, while remaining patients received medical therapy alone. Time intervals to initiation of cancer treatment and the impact of cancer treatment on the replaced valves were recorded. Logistic regression was performed to determine the impact of treatment strategy on overall survival (OS) in all 3 subgroups.Results.One hundred and eighty-seven cancer patients diagnosed with severe AS were identified. AVR was associated with better OS compared to medical therapy alone (p < 0.0001). TAVR was associated with better OS at 72 months (HR = 0.468, p < 0.001) compared to medical therapy alone, with no difference in OS observed between SAVR and TAVR. Time intervals to initiation of cancer treatments were shorter in the TAVR group, with no valve deterioration or infection observed in all groups.Conclusion.Cancer patients with severe AS benefit from AVR. TAVR is a viable alternative to SAVR in high-risk cancer patients to prolong survival and allow for earlier administration or resumption of anti-neoplastic therapies.

Early surgical correction of mitral valve infection endocarditis in 16-year old female patient

The optimal time for surgery on the heart valves in patients with active infectious endocarditis (IE) is still controversial. It is a well known fact that cerebral, coronary or renal thromboembolism is the most common cause of death in patients with left-sided IE. Thromboembolism can develop before the appearance of clinical manifestations of the destruction of the valvular apparatus of the heart. Currently, early surgical intervention is considered as the most effective method of treatment of many forms of active left-sided IE. Early surgery involves performing surgical correction until the completion of a full antibiotics course. We present the clinical case of early surgical correction of the patient (A., 16 years) with mitral valve infectious endocarditis. The disease was acute, with recurrent embolisms to the right kidney with infarction and to the left clavicle with osteomyelitis. Surgical intervention was performed as a matter of urgency; surgical access right-sided anterolateral thoracotomy. The girl was operated on the 4th day of the hospitalization to our hospital. However, time of treatment was lost at the prehospital stage and rapid mitral valve destruction did not allow to repair the valve. Therefore, the mitral valve replacement was performed. The postoperative period was favorable. On the 3rd day after the operation, the girl was transferred to the cardiology department. On control ECHO after 3 years: myocardial contractile function is good, EF 65%, the function of the MV prosthesis is not impaired.

ANTIMICROBIAL ACTIVITY OF ETHANOLIC EXTRACTS FROM LEAVES OF PISTACIA INTEGERRIMA (ANACARDIACEAE) STEW EX BRAND

Purpose: The ethanol extract of leaves of Pistacia integerrima (EEPI) was evaluated for antibacterial activity.&#x0D; Methods: The leaves of P. integerrima were collected from wild source and authenticated by Dr. Manoj Joshi, botanist environmental education expert, Una, HP, India. Antimicrobial activity was performed using the Mueller–Hinton (MH) agar using disk diffusion method. In the MH agar media 38 g after dissolving in 1000 ml of distilled water (pH 7.3±0.2), the extract was incorporated such that concentration per ml will be 66.67 μg, 133.33 and, 166.66.&#x0D; Results: The minimum inhibitory concentration recorded was 133.33 for Pseudomonas aeruginosa, Salmonella Typhi, and Klebsiella pneumonia, whereas 166.6 for Staphylococcus aureus, Coagulase-negative Staphylococcus, and Escherichia coli. The maximum zone of inhibition was found 19 mm and 18 mm for S. aureus and E. coli, respectively. S. aureus have been reported for skin pneumonia, heart valve, and bone infections whereas E. coli causes diarrhea and many other infections in children.&#x0D; Conclusion: After reporting the better zone of inhibition for these two bacteria, EEPI can be used to formulate better herbal remedy against them.

Esplenectomía laparoscópica por absceso esplénico secundario a endocarditis infecciosa

El absceso esplénico es una entidad clínica rara que se asocia con mayor frecuencia a endocarditis infecciosa. El reemplazo de la válvula cardíaca en el contexto de un absceso esplénico sin tratar se asocia con una alta incidencia de infección de válvula protésica y muerte. Se describe un paciente con endocarditis infecciosa y absceso esplénico tratado mediante esplenectomía laparoscópica seguida de reemplazo valvular.

Clinical and Multimodal Imaging Findings in Disseminated Mycobacterium Chimaera

To characterize the ophthalmic clinical and multimodal imaging findings of disseminated Mycobacterium chimaera infection after cardiothoracic surgery. Observational case series. Four patients (8 eyes) with disseminated M.chimaera infection. Patients were evaluated with biomicroscopy, OCT and OCT angiography, fundus autofluorescence, and fluorescein and indocyanine green angiography. Clinical and multimodal imaging findings of patients with disseminated M.chimaera infection. All 4 patients were white men with a mean age of 65.5 years (range, 60-75 years) who had aortic valve or root infection, or both, with M.chimaera diagnosed by culture, gene sequencing, or both. All 4 patients demonstrated bilateral choroidal lesions on funduscopy and evidence of osteomyelitis by imaging, culture analysis, or both at the time of ocular diagnosis. Indocyanine green and OCT angiography revealed numerous additional subclinical choroidal lesions and were used to track disease response to therapy. Fluorescein angiography and fundus autofluorescence were useful in determining lesion age and activity. All patients were treated with 3- or 4-drug antimycobacterial therapy. Three underwent revision of cardiothoracic surgery with removal of infected graft. One patient went on to demonstrate progressive ocular disease that was noted before each of his surgical revisions. Two patients showed improvement in ocular and systemic disease, however one of them developed a choroidal neovascular membrane. The final patient was a single encounter whose clinical and imaging findings showed longstanding inactive disease. Ophthalmologists should be aware of the systemic and ocular findings of this rare life-threatening disease. Multimodal imaging is useful in corroborating a diagnosis of ocular M.chimaera andparticularly in evaluating patient response to therapy, because choroidal activity seems to mimic systemic activity. Treating physicians should be aware of the co-occurrence of choroiditis and osteomyelitis. Choroidalneovascular membrane can also be a late complication of this disease.

Optimizing outcomes in infective endocarditis: A comprehensive literature review.

Despite being rare, infective endocarditis (IE) is a life-threatening disease with poor prognosis. New diagnostic and therapeutic strategies are emerging; however, predisposing factors and microbiology of the disease are also changing with time. Because of this, there has been a lack of reduction in the disease's incidence and new challenges for clinicians have arisen such as an increasingly aging population and growing antimicrobial resistance. In this paper, we aim to provide an overview of the changing trends in IE, current diagnosis, and management strategies, as well as the emerging role of the infective endocarditis teams in the care of patients with this disease. A comprehensive electronic search was done utilizing PubMed, Ovid, SCOPUS, Embase and google scholar. The search terms included 'Endocarditis', 'IE', 'Infection', 'Vegetation', 'Duke criteria', 'native valve infection', 'prosthetic valve', 'valve infection', 'endocarditis outcome' and 'endocarditis bacteriology'. The references of the identified articles were then searched for any potential articles that can be included. The inclusion criteria were any article that discussed the evidence behind incidence and management of IE including the role of endocarditis team. The exclusion criteria were case reports, expert opinion, and editorials. All the relevant findings are summarized in specified tables and within appropriate sections. It is vital to determine the current trends in the epidemiology and microbiology of the condition so that the diagnostic threshold can be adapted, to identify new at-risk groups and achieve an accelerated evaluation strategy that allows for earlier diagnosis and treatment. Management of IE can benefit from the input of different specialties, such as cardiology, cardiothoracic surgery, infectious disease, and microbiology. Therefore, adopting a multidisciplinary approach towards treatment is crucial to reduce morbidity and mortality from preventable complications of this pathology.

Infective endocarditis profile, prognostic factors and in-hospital mortality: 6-year trends from a tertiary university center in South America.

Infective endocarditis (IE) remains an expressive health problem with high morbimortality rates. Despite its importance, epidemiological and microbiological data remain scarce, especially in developing countries. This study aims to describe IE epidemiological, clinical, and microbiological profile in a tertiary university center in South America, and to identify in-hospital mortality rate and predictors. An observational, retrospective study of 167 patients, who fulfilled modified Duke's criteria during a six-year enrollment period, from January 2010 to December 2015.The primary outcome was defined as in-hospital mortality analyzed according to treatment received (clinical vs surgical). Multivariate analysis identified mortality predictors. The median age was 60 years (Q1 -Q3 50-71), and 66% were male. Echocardiogram demonstrated vegetations in 90.4%. An infective agent was identified in 76.6%, being Staphylococcus aureus (19%), Enterococcus (12%), coagulase-negative staphylococci (10%), and Streptococcus viridans (9.6%) the most prevalent. Overall in-hospital mortality was 41.9%, varying from 49.4% to 34.1%, in clinical and surgical patients, respectively (P = .047). On multivariate analysis, diabetes mellitus (odds ratio [OR], 2.5), previous structural heart disease (OR, 3.1), and mitral valve infection (OR, 2.1) were all-cause death predictors. Surgical treatment was the only variable related to a better outcomes (OR, 0.45; 95% Confidence Interval, 0.2-0.9). This study presents IE profile and all-cause mortality in a large patient's cohort, comprising a 6-years' time window, a rare initiative in developing countries. Elderly and male patients predominated, while S. aureus was the main microbiological agent. Patients conservatively treated presented higher mortality than surgically managed ones. Epidemiological studies from developing countries are essential to increase IE understanding.

Isolating Crucial Steps in Induction of Infective Endocarditis With Preclinical Modeling of Host Pathogen Interaction.

Animal models of Staphylococcus aureus infective endocarditis (IE), especially in rodents, are commonly used to investigate the underlying pathogenesis, disease progression, potential diagnostic approaches, and therapeutic treatment. All these models are based on surgical interventions, and imply valve trauma by placing a polyurethane catheter at the aortic root. While the influence of endothelial damage and inflammation on the induction of IE has been studied intensively, the role of the catheter, as permanent source of bacteremia, and the interplay with bacterial virulence factors during the formation of IE is poorly understood. In our study, we aimed at identifying which set of preconditions is required for induction and formation of IE: (1) tissue injury, (2) permanent presence of bacteria, and (3) presence of the full bacterial repertoire of adhesion proteins. We investigated the manifestation of the disease in different modifications of the animal model, considering different degrees of endothelial damage and the presence or absence of the catheter. In four infection models the induction of IE was assessed by using two bacterial strains with different expression patterns of virulence factors – S. aureus 6850 and Newman. In vivo magnetic resonance imaging showed conspicuous morphological structures on the aortic valves, when an endothelial damage and a continuous bacterial source were present simultaneously. Cellular and inflammatory pathophysiology were characterized additionally by histology, real-time quantitative polymerase chain reaction analysis, and bacterial counts, revealing strain-specific pathogenesis and manifestation of IE, crucially influenced by bacterial adherence and toxicity. The severity of IE was dependent on the degree of endothelial irritation. However, even severe endothelial damage in the absence of a permanent bacterial source resulted in reduced valve infection. The spread of bacteria to other organs was also dependent on the pathogenic profile of the infectious agent.

Surgical treatment of heart valve disease: Considerations for the dental management

AbstractThe number of valve surgeries is increasing with a change in the disease structure from rheumatic valvular heart disease (VHD) to arteriosclerotic or degenerative VHD. The treatment strategies for VHD have also been changing over the last two decades. Repair techniques for valve regurgitation have been established with excellent long‐term clinical results. As valve repair has advantages over prosthetic valve replacement in terms of avoidance of anticoagulation and reduced risk of valve infection, it has become the first choice for treatment of degenerative VHD even for infective endocarditis, which is closely related to dental procedures. With the development of technologies, minimally invasive cardiac surgery is evolving, including the introduction of video‐assisted or robotically assisted valve surgeries via minithoracotomy, or percutaneous transcatheter therapies. Notably, recently introduced transcatheter aortic valve replacement has shown excellent clinical results compared to surgical aortic valve replacement and has become a standard therapy for aortic stenosis in the elderly. Reoperative aortic valve replacement for degenerated bioprosthetic valve can also be performed using the transcatheter “Valve in Valve” technique. These minimally invasive approaches are likely to become more widely adopted and may determine the scope of therapeutic strategies for VHD into the future.

Recurrent infective endocarditis in a patient after a second Melody valve placement

A 16-year-old Caucasian male was diagnosed with recurrent infective endocarditis associated with his second Melody valve placed inside a previously treated infected Melody valve. The replacement of Melody valve after the first infective endocarditis episode might increase the risk of the second episode of infective endocarditis.

Abstract 215: Cardiac Surgeons' Treatment Preferences for Infective Endocarditis Based on Patients' Drug Use Status

Purpose: With the current opioid epidemic, U.S. cardiac surgeons are increasingly facing complex medical decision-making for patients with injection drug use-associated infective endocarditis (IDU-IE). Guidelines for IE recommend that normal indications for surgery be applied to IDU-IE. We evaluated cardiac surgeons’ treatment preferences for IDU and non-IDU-IE. Methods: We sent an anonymous survey to 2398 cardiac surgeons in the U.S., of whom 254 (10.6%) responded. Of those respondents, 208 completed the questions of interest. Treatment options were presented as hypothetical clinical scenarios of IE with categorical responses. Scenarios varied based on patient drug use status, patient adherence to addiction treatment, and nature of the valve (recurrent vs. native). Treatment preferences were classified as operative vs non-operative. McNemar and Wilcoxon signed-rank tests were used to determine differences in response to scenarios. Statistical significance was defined as P&lt; 0.05. Respondents’ demographic data were collected. Results: In patients with native valve non-IDU-IE, 131 (63%) would operate, and 77 (37%) would not. For patients with native valve IDU-IE and adherent to addiction treatment, 76 (36.5%) would not operate, while 132 (64.5%) would. In cases of recurrent IE, 175 (93.1%) surgeons would operate on non-IDU-IE vs 55 (26.4%) on IDU-IE. The difference in treatment preference for recurrent IDU-IE vs recurrent non-IDU-IE was statistically significant by McNemar’s test (OR 0.16, CI [0.08, 0.27] P &lt;0.001). Nearly three quarters (152, 73.1%) stated no limits on operations for non-IDU-IE in case of recurrence, vs 34 (16.5%) for IDU-IE. Others limited to 1 (83, 40.3%), 2 (79, 38.4%),or 3 (10, 4.9%) operations for IDU-IE, vs 1 (13, 6.3%), 2 (30, 14.5%) or 3 (13, 6.3%) for non-IDU-IE. Wilcoxon signed-rank test showed a statistically significant difference in the limit number of operations for recurrent non-IDU-IE vs recurrent IDU-IE (z = -4.9, P &lt;0.001). Most respondents report having denied operating for IDU-IE (132, 63.5%), unlike 49 (23.6%) who have not, while 24 (11.5%) have delayed operating. Most respondents who have denied operating did not refer patients to a different surgeon or hospital. Active drug use and recurrent endocarditis were the leading reasons cited for denying operating for IDU-IE. Conclusion: Cardiac surgeons have different treatment preference for IE based on patients' underlying substance use disorder diagnosis. Surgeons are less likely to offer operation for primary and recurrent valve infection to patients with IDU-IE, and patient adherence to addiction treatment may be protective against denial of operation. This indicates a need for increased education of cardiac surgeons on addiction, and a multidisciplinary approach to care in order to address the disparity in treatment and management between IDU-IE and non-IDU-IE.

Comparison of Clinical Outcomes Seprate and semi continus sewing methods during and after Heart valves Surgery

Background and Aims: Various therapies and surgeries are applied in heart valve surgery, including interrupted and semi-continuous suture techniques. Therefore, this study aimed to compare the clinical implications of two methods of interrupted and semi-continuous suture techniques during and after mitral or aortic valve replacement surgery among patients referred to Department of Surgery, School of Medicine, Birjand University of Medical Sciences. Materials and Methods: In this study, the required information of patients was collected through the checklist based on the objectives of the study. The subjects had undergone aortic or mitral valve replacement for heart valve replacement suturing with continuous or interrupted suturing techniques. The patientschr('39') records were examined to investigate the complications, and in case that the required information was not registered, the patient or his relatives were also contacted so that the patient could be examined and referred to the hospital by the patientchr('39')s surgeon. Results: The mean age scores of patients undergoing surgery in the continuous and interrupted suture groups were obtained as 53.06±13.48 and 52.86±12.97 years, respectively. It was revealed that there was a large distribution of heart valve leakage, arrhythmia, heart attack, valve infection, involved valve type, and aortic and mitral valve size in the two groups; however, there was no significant difference (P&gt;0.05). Conclusion: Based on the results of this study, the rate of cardiac function and complications caused by the two techniques of continuous and interrupted suturing were not significantly different from each other; therefore, these two methods were not superior to each other due to the mentioned cases.