Late Prosthetic Endocarditis Research Articles

Redo aortic root operations in late prosthetic endocarditis: clinical case series

Prosthetic aortic valve endocarditis is a severe disease that quickly leads to heart failure. Owing to microorganisms and their toxins constantly entering the bloodstream, bypassing biological barriers, and hemodynamic disturbances, systemic embolism develops quite quickly, leading to sepsis and multi-organ failure. Conservative antibiotic therapy is often not effective because the infectious focus is located in the avascular zone. The presence of an implanted foreign body promotes adhesion of bacteria on the surface of the prosthetic tissue with simultaneous isolation from the action of phagocytes. Conservative treatment of prosthetic infectious endocarditis has an extremely unfavourable prognosis. Hospital mortality without operation is approximately 80%. Operations for prosthetic infectious endocarditis of the aortic valve are technically complex and require a highly qualified operating surgeon. The most difficult operations involve extension of the abscess to the aortic root, area of mitralaortic continuity and left ventricular outflow tract. In such situations, it is necessary to perform complex reconstructive operations on the aortic root, mitral-aortic continuity and left ventricular outflow tract. This study presents an overview of a series of complex redo operations on the aortic root and the ascending aorta in late prosthetic infectious endocarditis, with an analysis of the main tactical and technical aspects of the operations. Moreover, similar operations can be performed with good results by an experienced cardiac surgeon. In this case, it is necessary that prior to operation, the surgeon develops an algorithm of actions and determines 1) optimal access to the heart, 2) perfusion scheme, 3) type of implantable conduit, 4) cardiolysis performance features, 5) myocardial protection scheme and 6) features of the treatment of the infectious focus.Received 29 October 2019. Revised 19 December 2019. Accepted 23 December 2019.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.Author contributionsDrafting the article: I.I. Skopin, P.V. Kakhktsyan, M.S. Latyshev, D.V. Murysova, T.A. Kupriy, I.A. ZhangerievCritical revision of the article: I.I. Skopin, P.V. Kakhktsyan, M.S. Latyshev, D.V. Murysova, T.A. Kupriy, I.A. Zhangeriev, E.V. Khasigova, L.Zh. EnokyanSurgical treatment I.I. Skopin, P.V. KakhktsyanDiagnostics: L.Zh. EnokyanTreatment: D.V. Murysova, T.A. KupriyAssistance in surgery: M.S. Latyshev, E.V. KhasigovaFinal approval of the version to be published: I.I. Skopin, P.V. Kakhktsyan, M.S. Latyshev, D.V. Murysova, T.A. Kupriy, I.A. Zhangeriev, E.V. Khasigova, L.Zh. Enokyan

Случай успешного хирургического лечения позднего протезного эндокардита у пациента 80 лет с высоким операционным риском

Случай успешного хирургического лечения позднего протезного эндокардита у пациента 80 лет с высоким операционным риском

Clinical features and prognosis of prosthetic valve endocarditis

PurposeTo analysis the clinical characteristics and outcomes of prosthetic valve endocarditis.MethodsThe study population comprised 40 consecutive patients who fulfilled the modified Duke criteria for prosthetic valve endocarditis from May 2005...

Prosthetic Valve Endocarditis in a Multicenter Registry of Chinese Patients

We evaluated the clinical outcomes of prosthetic valve endocarditis in 2 major tertiary referral centers in Hong Kong. The study population comprised 80 consecutive Chinese patients who fulfilled the modified Duke criteria for prosthetic valve endocarditis from March 2000 to June 2007. The major clinical endpoints analyzed were hospital mortality, need for valve surgery, and relapse of prosthetic endocarditis. The mean age at presentation was 56 ± 13 years, with a slight male preponderance. There were 76 (95%) patients with involvement of a mechanical prosthesis; the majority (69%) had late prosthetic endocarditis. Major hospital complications occurred in 49 (61%) patients. The overall hospital mortality was 28% (22 patients). Thirty-four (42%) patients required valve surgery during index hospitalization, of whom 5 (15%) died due to uncontrolled sepsis. Factors associated with hospital mortality were older age at presentation, Staphylococcus aureus infection, embolic events, severe heart failure, valve surgery, and any major complication. On multivariate analysis, severe heart failure was the only independent predictor of hospital death. Among the 58 hospital survivors followed up for a mean of 48 ± 31 months, 6 (10%) developed late complications related to prosthetic valve endocarditis, with 5 documented cases of relapse.

Fístula aorta-aurícula derecha como complicación de endocarditis protésica precoz

Early infectious endocarditis occurs in 3% of prostheses in the first 12 months after valvular surgery and is more aggressive than late prosthetic endocarditis. Mortality remains high, especially in early cases, despite combined medical and surgical treatment. Clinical manifestations of early cases are due to both bacteremia and prosthetic malfunction, and is mainly caused by staphylococci. We present a case report of early prosthetic endocarditis in aortic prostheses complicated with severe aortic regurgitation and right atria-aortic root fistula with auriculoventricular and intraventricular disturbance in electrocardiogram.

Valva mitral heteróloga sem suporte: resultados clínicos a médio prazo

The concept of replacing diseased mitral valve with porcine mitral stentless valve allowed to address the idiosyncrasy of the left ventricular flow and contractility. From March 92 to December 95, 108 patients had their mitral valves replaced by stentless mitral valves. Their age varied from 11 to 65 years (mean 35.22 ± 14.98). There were 67 (62%) females and 41 (38%) males. The predominant ethiology was rheumatic heart disease 94 (87%) cases, followed by a prosthetic dysfunction 6 (5.6%) cases, myxomatous disease 5 (4.6%) cases, infective endocarditis 2 (1.9%) cases and ischemic lesion 1 (0.9%) case, 26 (24.1%) patients had mitral stenosis, 24 (22.2%) mitral regurgitation and the remaining 58 (53.7%) mixed lesions; 21.3% of the patients had previous open heart operations. The great majority of the operated patients (97.2%) were in functional class III and IV (NYHA). Associated procedures were performed in 9.3% (10) of the cases. RESULTS: Hospital mortality occurred in 7 (6.5%) patients non valved related with exception of one whom developed early endocarditis. Of the 101 remaining 3 required reoperations, in two due to valved size mismatch and 1 due to papillary muscle tear. Of the 98 remaining patients, 2 were lost to follow-up, 96 patients have been followed for 3.2 to 45 months. During the late follow-up there were six (6.25%) deaths, of the 3 patients with late prosthetic endocarditis, 2 had their valves replaced with standard bioprosthesis, with one death. The third patient expired before reoperation. The late death patient (mitral insufficiency) died early after reoperation. The other 3 patients expired: 1 due to myocardial infarction, 1 due to stroke and 1 with pancreatitis. LATE REOPERATIONS: There were 12 patients reoperated, in 8 due to mitral regurgitation with one death, in 2 due to decrease of the mitral valve area, and 2 late endocarditis with one death. CURRENT CLINICAL FOLLOW-UP: 80 patients are being currently followed. The ecodopplercardiographic studies have shown 63 patients with normal functioning mitral stentless valves, 15 with mild but stable mitral regurgitation and two with reduction on the mitral valve area by the pressure half time. In all but two, serial echocardiographic studies have shown improvement in the left ventricular function, with decreased end systolic and end diastolic volumes. CONCLUSION: Porcine mitral stentless valves have shown better performance, are hemodynamicaly superior with greater possibility of maintaining normal ventricular size and function. Although this study showed a distinct learning curve related to the new product and technique, these can be overcome by training and following current described operative technique.

Echocardiographic assessment of prosthetic valve endocarditis.

Prosthetic valve endocarditis is still a very serious complication, carrying an incidence of death between 30 and 70% in some series. Therefore early and accurate diagnosis is crucial. Early (less than 60 days post surgery) endocarditis is usually a fulminant disease, where staphylococcal infection is most common. Late prosthetic endocarditis resembles more closely other forms of the disease. Conventional echocardiography is useful in the evaluation of prosthetic valve function, but it is very limited in the demonstration of infective lesions, primarily because of acoustic shadowing. Transoesophageal echocardiography (TE) enables high resolution imaging of the heart without chest wall interference, and viewing of the heart from the posterior (atrial, low pressure) side, where most of the vegetations are expected to be found in both mitral and tricuspid positions. It also enables better visualization of the left ventricular outflow tract, where aortic prosthetic vegetations tend to be present. Furthermore, transoesophageal echocardiography allows accurate diagnosis of some of the common complications of endocarditis: abscess/cavity formation; mycotic aneurysm; prosthetic valve dehiscence and regurgitation. In spite of these advantages, limitations should be recognized. Struts are commonly seen on transoesophageal echocardiography following surgery and should not be confused with vegetations. Similarly, normal prosthetic regurgitation should not be confused with paravalvar leakage. Nevertheless, transoesophageal echocardiography, when expertly used, changes the possibility for early and more accurate diagnosis of prosthetic valve endocarditis dramatically. Transoesophageal echocardiography should be included among the major criteria in the diagnosis and follow-up of prosthetic valve endocarditis.