Surgical Treatment Of Active Endocarditis Research Articles

Experience in surgical treatment for active endocarditis at Ho Chi Minh Institute

Background: Surgical treatment for active infective endocarditis are always complex with many severe complications. Indications for surgery and the timing of surgery are still debated. 
 Patient and Method: retrospected all infective endocarditis patients who were operated on at HCM Heart Institute from 1995 to 2020 and focused on the group of active infective endocarditis.
 Results: 
 In total, there have 568 infective endocarditis patients were operated and among that active infective endocarditis were 138 patients (24.3%). In this group, according to pathology were as follows:15 on the native valve, 30 on the congenital defect, 56 on previous valvular heart disease, 2 post pace marker, and 35 on post valvular surgery. In most cases, pathogens of endocarditis were Streptococci spp (42%) and Staphyloccocus aureus (29,7%). Per operation, 100% of cases find out vegetations and 42 cases have an annular abscess.
 The surgical procedure was as follows: vegetations ablation and radical repair of congenital defect:30; valve repair: 24; valve replacement: 77; electrodes ablation: 2, and Bentall’s procedure: 5. Operative mortality was 11 cases (8%): 3 cerebral hemorrhages, 3 multi-organ failure, and 4 low cardiac output. The median time of follow-up was 11.2 years. Redo in the 1st 3month and after 1 year caused by desinsertion ring or valve prosthesis were 12 cases and 4 cases, respectively. Late death after 1 year was 6 (4 irreversible HF, 1 cerebral hemorrhage, and 1 sudden death). The rest cases have been stable.
 Conclusion
 Surgical treatment for active infective endocarditis has good results although the outcome is complex and the duration of hospital stay is very long. Early surgery for active infective endocarditis could solve radical infective lesions with a mortality rate acceptable.

Surgical experience with infective endocarditis and aortic root abscess.

PurposeThis study was conducted to evaluate the surgical outcomes of active infective endocarditis with aortic root abscess formation.Materials and MethodsBetween February 1999 and June 2012, 49 patients underwent surgery for active endocarditis with aortic root abscess. The infected valve was native in 29 patients and prosthetic in 20 patients. The patients' mean age was 50±14 years, and 36 patients were male. Surgery was urgent/emergent in 15 patients (31%). The abscess involved the aortic annulus (11), left ventricular outflow tract (18), fibrous trigone (16), and mitral annulus (4). In all patients, wide debridement of abscess and aortic valve replacement with or without patch reconstruction of aortic root or annulus was performed.ResultsThere were 6 (12%) operative deaths. Causes of early mortality were sepsis (2) and multi-organ failure (4). On postoperative echocardiogram, there was significant improvement of left ventricular dimension (LVEDD, from 58.8±11.8 mm to 52.6±8.2 mm, p<0.001); however, LV ejection fraction was significantly decreased (from 61.4±12.0% to 49.8±16.5%, p<0.001). The mean follow-up duration was 68.7±40.4 months. There was no late death or recurrent endocarditis during follow up. New York Heart Association functional class significantly improved from 3.2±0.7 to 1.2±0.4 (p<0.001). Kaplan-Meier estimated survival at 10 years was 87.2%.ConclusionSurgical treatment for active endocarditis with aortic root abscess is still challenging, and was associated with high operative mortality. Nevertheless, long-term survival was excellent with good functional capacity after recovery from the early postoperative period.

Is simultaneous splenectomy an additive risk factor in surgical treatment for active endocarditis?

Splenic abscess formation is a serious complication in the setting of active endocarditis, and splenectomy is recommended. However, the optimal timing for splenectomy is yet undetermined. The purpose of this study was to evaluate the role of a one-stage splenectomy and valve surgery for active endocarditis. Among 202 consecutive endocarditis patients, 18 had splenic lesions on preoperative abdominal screening, who underwent cardiac surgery and splenectomy as a one-stage procedure (group A) and were compared to patients with unremarkable abdominal screening (group B, n = 184) undergoing sole cardiac surgery. No difference was observed regarding preoperative characteristics (age, gender, New York Heart Association [NYHA] grade, diabetes, coronary artery disease, redo surgery, adiposity, smoking), intubation time, and prolonged ventilation. There were 23 early postoperative deaths in group B (12.5%) vs. none in group A. At 180days, survival was significantly higher for patients in group A (94.4%) vs. group B (67.9%, p = 0.016), although this difference did not reach statistical significance (log-rank test, p = 0.073). Multivariate Cox proportional hazards regression revealed age above 50years (hazard ratio [HR] 3.327, 95% confidence interval [CI] 1.279-8.650) and NYHA class above III (NYHA III or IV: HR 3.117, 95% CI 1.119-8.683, p = 0.030; NYHA IV: HR 3.678, 95% CI 1.984-6.817, p < 0.001) as independent risk factors for mortality at 180days. A trend towards a protective factor was observed for simultaneous splenectomy (HR = 0.171, 95% CI 0.023-1.255). Simultaneous valve surgery and splenectomy is an approach for active endocarditis complicated by splenic lesions with a low 180-day mortality. Despite the expected risk elevation by septic lesions and the additive trauma of a laparotomy, patients with simultaneous splenectomy had a favourable outcome regarding early mortality and mortality at 6months.

Prosthetic valve sewing-ring sealing with antibiotic and fibrin glue in infective endocarditis. A prospective clinical study

To analyze the benefits of prosthetic valve sewing ring sealing with antibiotic and fibrin glue in endocarditis, a prospective study was undertaken in 16 consecutive patients. Valvular lesions concerned aortic valve in seven patients, mitral valve in three and both in six. Preoperative antibiotic treatment was started 15+/-15 days before surgery. Peroperative findings showed six isolated valvular lesions and ten perivalvular extensions. Before the prostheses were sutured to the annulus, the Dacron sewing rings were covered with antibiotic and fibrin glue. The antibiotic was chosen according to the micro-organism identified preoperatively. We didn't have any peroperative mortality or paravalvular leakage (PVL). One patient died suddenly on postoperative day (POD) nine (non-contributive autopsy). Another patient was reoperated on POD 31 for PVL. Peroperative local bacteriological examinations were sterile. Mean follow-up was of 9.3+/-6.8 months and was completed in all cases. Actuarial survival rate was 94+/-6% and freedom from reoperation was 92+/-7%. Antibiotic treatment was stopped after 59+/-64 days for 10 patients. None of them had recurrence of endocarditis or PVL. Prosthetic valve sewing ring sealing with adapted antibiotic and fibrin glue can constitute a good weapon in the armamentarium of surgical treatment of active endocarditis.