Surgical Treatment Of Infective Endocarditis Research Articles

An infrared coagulator to assist surgical treatment of infective endocarditis.

We previously demonstrated that infrared coagulator IRK-151 (Lumatec, Deisenhofen, Germany) is capable of creating a transmural lesion while preserving the epicardium and endocardium of the beating right atrium and right ventricle in a canine model (1). Since the original IRK-151 model contains a 3-sec timer and its plastic body is not strong enough to tolerate long coagulation times, we modified it by replacing the body with reinforced heat-resistant plastic and substituting a digital programmable timer so that it would be strong enough to perform myocardial ablation, and we demonstrated that the coagulator is capable of creating a conduction block on the beating right atrium clinically (2).

Surgical Treatment of Infective Endocarditis in Pulmonary Position-15 Years Single Centre Experience.

Background and Objectives: Infective endocarditis in the pulmonary position is a rare disease. Isolated pulmonary valve endocarditis is extremely rare. The aim of our study was to assess patients who were treated surgically for pulmonary endocarditis at our institution from January 2003 to December 2017. Materials and Methods: We analyze eight cases of infectious endocarditis in pulmonary position out of 293 patients who were operated for infective endocarditis (2.7%, 8/293). Only two of these eight patients were not related to congenital heart malformation. They were followed for early and late mortality, long-term survival, postoperative morbidity and reoperations. Results: Among six patients suffering from congenital heart disease, four patients underwent corrections of pulmonary valve malformation previously, and their infected grafts were replaced by two allografts and two xenografts. The two other patients had replaced their infected pulmonary valves with allografts. Two non-congenital patients with pulmonary valve endocarditis underwent valve replacement with biological prosthesis. All patients survived the early postoperative course. The mean follow-up time was 9.1 (interquartile range (IQR), 5.3–12.6) years. The long-term follow-up included seven patients. One patient (12.5%, 1/8) died more than 4 years after the surgery due to sepsis. Pulmonary endocarditis was the rarest endocarditis treated surgically (p < 0.001). Conclusion: Surgery for infective endocarditis in the pulmonary position (IEPP) is an effective method of treatment with excellent early outcome and good late results despite a very uncommon pathology and few operations being performed. Surgery performed earlier may make the procedure less radical.

Predictors of early mortality after surgical treatment of infective endocarditis: a single-center experience.

Surgical management of infective endocarditis continues to be challenging and is associated with significant morbidity and mortality. The objective of our study was to determine the risk factors and conditions associated with poor early infective endocarditis surgical treatment outcomes-30-day postoperative mortality. A total of 124 patients who underwent surgery for infective endocarditis at the Hospital of Lithuanian University of Health Sciences Kaunas Clinics from January 2010 to December 2017 were retrospectively included in this study. The primary endpoints were 30-day postoperative mortality and identification of risk factors associated with it. Secondary endpoints were early postoperative outcomes and complication rates. During the study period, 124 patients with infective endocarditis underwent cardiac surgery, presenting an overall 30-day postoperative mortality rate of 10.48%. Mean age was 58 ± 14.4 years with 95 (76.61%) males. Independent predictive factors of early mortality were age >63 years (odds ratio = 6.4, 95% confidence interval = 1.66-24.66, p = 0.003), body mass index >30 kg/m² (odds ratio = 7.74, 95% confidence interval = 2.20-27.27, p = 0.003), and ischemic heart disease (odds ratio, 6.6, 95% confidence interval = 1.62-26.90, p = 0.003), as well as intraoperative parameters-prolonged aortic cross-clamp >84.5 minutes (odds ratio = 3.79, 95% confidence interval = 1.10-13.08, p = 0.03) and cardiopulmonary bypass time >107.5 minutes (odds ratio = 10.0, 95% confidence interval = 1.26-79.58, p = 0.023). Staphylococcus aureus infection (odds ratio = 5.04, 95% confidence interval = 1.29-19.64, p = 0.012), infective endocarditis-related intracardiac complication such as paravalvular abscess detected by transesophageal echocardiography (odds ratio = 4.32, 95% confidence interval = 1.31-14.25, p = 0.01), and infective endocarditis complicated by septic or cardiogenic shock (odds ratio, 18.43, 95% confidence interval = 4.59-73.98, p = 0.001) were statistically significant factors for increased risk of 30-day postoperative mortality. Surgical treatment of infective endocarditis showed good results in our center. The independent predictors of 30-day postoperative mortality for patients who underwent cardiac surgery for infective endocarditis were age, body mass index, ischemic heart disease, prolonged aortic cross-clamp and cardiopulmonary bypass time, Staphylococcus aureus infection, paravalvular abscess, and septic or cardiogenic shock.

Experience of surgical treatment of infective endocarditis in children

Surgical treatment of infectious endocarditis in children, single-center experience. The paper analyzes the experience of surgical treatment of infectious endocarditis (IE) in children. In the period from January 1999 to July 2019, 69 children with IE were operated at National Amosov Institute of Cardiovascular Surgery of NAMS of Ukraine, 44 of them (63.8%) developed the disease on the background of congenital heart defects (CHD). The mean age of the patients at the time of surgery was 9.1 ± 6.1 years. The average weight is 31.5 ± 21.7 (3.6 to 85 kg). The duration of the disease at the time of hospitalization was 5.3 ± 1.1 months. The average duration of the fever before hospitalization was 10.2 ± 8.5 weeks. Among the causes of IE, we observed three groups of inflammatory diseases: infections of the skin and subcutaneous fat in 15 (21.7%) cases, pathology of ENT – organs – 14 (20.2%) and broncho-pulmonary diseases – 9 (13.1%) cases. The risk factors were: presence of CHD – 44 (63.7%) and also nosocomial factors. The microbiological spectrum of pathogens included gram-positive microorganisms – 33 (71.7%), gram-negative microorganisms 4 (8.7%) and fungal microflora 9 (19.6%). The mean values of bypass circulation were 111.5 ± 62.4 minutes, and the time of aortic clamping was 71.4 ± 43.9 minutes, respectively. Hospital mortality in the general group of patients was 4 (5.8%) cases. In the follow-up period, 59 patients were examined, representing 90.7% of those discharged at the hospital stage. The observation period lasted from one month to 19.4 years (9.6 ± 5.7 years). According to the Kaplan-Meier analysis, the cumulative survival rate of patients in the CHD group at one year after surgery was 97.1%, at 10 years – 93.5%; after 15 years – 93.5%. Survival in the non-CHD group at 5, 10, and 15 years was 100%. In the long term, two patients died (3.4%). The recurrence rate of IE in the distant period was 2 (3.4%) cases. The incidence of long-term reoperation was 8 (13.6%) cases, three were recurrent IE and five were non-recurrent. According to Kaplan-Meier analysis, the proportion of patients without recurrent surgery in the long-term follow-up at 5 years was 87.9%, at 10 years – 84.1%, after 15 years – 77.1% in the CHD group. In the group without CHD 5 years – 95.2%, 10 years – 95.2%, 15 years – 81.6%. In the long term, as a result of performed surgical interventions, the regression of clinical manifestations of heart failure was noted in the majority of patients.

Evaluation of Perioperative Data in Patients with Infective Endocarditis Due to Antibiotic-Resistant Strains, Operated with the Use of Hyperthermic Perfusion

Objectives. Due to reduction of terms of in-hospital treatment and increased range of community-acquired medical interventions risk of infective endocarditis (IE) due to antibiotic-resistant microorganisms increases. Surgical treatment of IE due to antibiotic resistant strains requires complex approach including the terms of surgical intervention, rational etiotropic antibiotic therapy, adequate materials for intracardiac reconstructions, hyperthermic per-fusion during bypass and careful perioperative management.&#x0D; The objective of the study was to describe the influence of antibiotic resistance on clinical course and results of surgical treatment in patients with infective endocarditis, operated with the use of hyperthermic perfusion.&#x0D; Materials and methods. Clinical data of 227 consequent patients with active infective endocarditis, operated from 01/01/2016 to 01/11/2018 were analyzed. The mean age was 48.7 ± 15.5 years. Gram-positive microorganisms were identified in 210 (92.5%) cases. Among them vancomycin-resistant strains composed – 46 (22.1%)cases. Gram-negative cultures were found in 17 (7.5%) cases. In this group the rate of carbapenem-resistant strains reached 47.1% (8 cases). Patients were operated with the use of total controlled hyperthermic perfusion (TCHP). Comparative analysis of perioperative data was carried out.&#x0D; Results. The group of patients with IE due to antibiotic-resistant strains (N = 54) was characterized by a higher frequency of redo interventions for replacement of infected valves – 7 (12.9%) cases, intracardiac abscesses – 13 (24.1%) cases, and lower frequency of valve-repair procedures – 5 (9.2%) cases, indicating a significant degree of initial degradation of the valve (p &lt; 0.05). Despite the absence of influence of the duration of aortic cross-clamping time, the total bypass time in the antibiotic-resistant group was significantly higher (p = 0.021). Analysis of hemodynamic status of patients revealed that the dose and duration of sympatho-mimetic administration were significantly higher in the group of patients with resistant microorganisms: dobutamine – 3.7 ± 0.6 ?g/kg/min and 113.2 ± 2.1 hours; norepinephrine – 0.09 ± 0.01 ?g/kg/min and 12.3 ± 2.1 hours respectively (p &lt; 0.001). Surgical interventions in patients with IE due to antibiotic-resistant strains, had higher frequency of postoperative heart failure – 30.8% cases (p = 0.002) and hospital mortality – 5,8% (p = 0.017) cases.&#x0D; Conclusions. Application of TCHP allowed to decrease hospital mortality to 5.8% in surgical treatment of patients with IE, caused by antibiotic-resistant strains of microorganisms.

Results of Surgical Treatment of Infective Endocarditis Complicated with Lung Impairment

The initial lung impairment in patients with infective endocarditis (IE) has a negative impact on the results of surgical treatment and rate of postoperative respiratory failure (RF). Mechanisms of development of RF are quite complicated, but the leading role is played by the initial septic lesion of pulmonary tissue in IE and surgical treatment with the use of cardio-pulmonary bypass.&#x0D; The aim of the study was to analyze results of surgical treatment of patients with IE, operated with the use of cardio-pulmonary bypass, implementing the method of intraoperative lung protection.&#x0D; Materials and methods. The basis of the study was clinical data of 663 patients with IE who were examined and treated at the SE “Amosov National Institute of Cardiovascular Surgery of NAMS of Ukraine” from 01.01.2016 to 01.01.2018. Diagnosis of IE was established according to the Duke University criteria Anesthetic support was carried out in accordance with standard techniques. For intraoperative lung protection, together with perfusion of the pulmonary artery with arterial blood, the mechanical ventilation was maintained for the period of bypass circulation. For determination of pathomorphological changes of lungs in patients with IE, histological analysis of intraoperative lung biopsy was performed.&#x0D; Results. In the surgical treatment of patients with IE with the use of standard method of anesthesia support, the rate of RF in the early postoperative period was 52 (7.8%) cases. The use of the modified method of intraoperative management led to the decrease of the signs of adults respiratory distress syndrome during the postperfusion period: decrease in the edema liquid in the alveolar lumen (p = 0.027), decrease in protein precipitate in the alveolar lumen (p = 0.031), decrease in the incidence of signs of alveoli collapse (p = 0.002). The use of the lung protection method offset the negative impact of intraoperative volume of blood transfusion on the lung function after surgery and the duration of mechanical ventilation (r = 0.121, p = 0.522). The introduction of lung protective in patients with IE, operated with the use of cardio-pulmonary bypass, contributed to decrease in the rate of RF in the early postoperative period from 7.9% to 2.8% of cases in the study groups.&#x0D; Conclusions. Implementation of the new protocol allowed to conduct long-term surgical interventions with the use of cardio-pulmonary bypass without increasing duration of mechanical ventilation and reducing the oxygenation index in the postoperative period, and contributed to the decrease in the frequency of postoperative RF.

Management of infective endocarditis in patients with post-stroke brain damages

This study evaluated the effectiveness of anesthesiological management in sur-gical treatment of infective endocarditis with cerebrovascular complications. The aim of the study was to decrease neurological complications and hospital mortality after surgical inter-ventions with the use of cardiopulmonary bypass in patients with infective endocarditis.&#x0D; The main preoperative risk factors of endocardit-associated cerebrovascular complications, which influenced the immediate results of cardiac surgery were: sepsis, systemic inflammatory response, disorders of systemic hemodynamics, high risk of recurrent cerebrovascular events, anemia and carbohydrate disorders. New anesthesiological management protocol was de-veloped and improved.&#x0D; Intraoperative risk factors for hospital mortality were associated with: total protein at the end of surgery less than 49 g/l; maximum blood glucose during surgery more than 10.7 mmol/l; anemia and hemodilution – hemoglobin level less than 58.8 g/l in the period of complete bypass and less than 79.4 g/l at the end of the surgery; positive water balance at the end of the operation.&#x0D; Determination of preoperative blood S100? protein level may be recommended to determine the prognosis of postoperative neurological complications, since the level above 0.13 µg/l was associated with postoperative neurological impairment.&#x0D; The implemented changes in the anesthetic management permitted to decrease neuro-logical complication rate from 22.2% to 9.6% and thirty-day mortality from 19.0% to 2.7% after surgical treatment of infective endocarditis with the use of cardiopulmonary bypass in patients with cerebrovascular complications.&#x0D; In order to achieve maximum effectiveness of anesthesiological management and to re-duce the level of postoperative neurological complications the optimal timing for surgery was 2–3 days after development of cerebrovascular impairment. In case of ischemic stroke in the most acute phase of the course (the first 72 hours), emergency cardiac surgery was advisable (except the cases of brain coma or total volume of myocardial infarction exceeding 31.5 cm3). In the case of ischemic stroke, more than 72 hours after the onset, and in the absence of progression of acute heart failure, the recommended timing for cardiac surgery was 4 weeks after the manifestation of cerebrovascular impairment. In the case of hemorrhagic or mixed type of neurological impairment, cardiac surgery was postponed for 1.4–2 months (since the development of the stroke).

Daptomycin-containing regimens for treatment of Gram-positive endocarditis

Infective endocarditis (IE) is a severe infection, and a leading cause of mortality and morbidity. Due to its favourable microbiological and pharmacological characteristics, daptomycin is routinely used in clinical practice for treating IE. A prospective study was conducted at a large tertiary-care hospital in Italy over an 8-year period (January 2010-January 2018) on all patients with native-valve endocarditis (NVE) or prosthetic-valve endocarditis (PVE) caused by Gram-positive bacteria. Patients with NVE and PVE treated with regimens that included daptomycin at different dosages (daptomycin-containing regimens, DCR) were compared with those treated with non-DCR. Primary endpoints of the study were 30-day mortality and clinical treatment failure. During the study period, 327 patients with Gram-positive NVE (n = 224, 68.8%) or PVE (n = 103, 31.2%) were analysed. Eighty-four (37.5%) NVE patients were treated with daptomycin, alone (59.9%) or with other antimicrobials. Most PVE patients (n = 61, 58%) were treated with a DCR, which always consisted of daptomycin plus other drugs. Among PVE patients, treatment with a DCR was associated with lower 30-day mortality than treatment with a non-DCR (6.5% vs. 38%, P < 0.001). Among NVE patients treated with DCRs, risk factors for 30-day mortality were streptococcal infections, persistent bacteraemia, and standard-dose (4-6 mg/kg) rather than high-dose daptomycin therapy. Overall, surgical treatment of IE and DCR were associated with clinical success and 30-day survival. Compared with non-DCRs, using single-drug or multiple-drug DCRs is associated with lower 30-day mortality in PVE, but with higher 30-day mortality in NVE at approved doses and in a subgroup of streptococcal IE.

Clinical Analysis of 161 Cases of Surgical Treatment of Infective Endocarditis.

Objective: To evaluate the diagnostic criteria, surgical indications, and prognostic factors in the surgical treatment of infective endocarditis (IE). Methods: A total of 161 cases of post-operative IE treated at our hospital from January 2007 to December 2016 were included. The IE was diagnosed by the modified Duke criteria. Echocardiography and standard blood cultures were performed. These cases were divided into severe and non-severe adverse event groups. The association between prognostic factors and severe versus non-severe outcomes was examined using logistic regression. Results: Thirty patients (20.1%) with post-operative IE had positive pre-operative blood cultures, and 130 patients (80.7%) had valve vegetations. Four patients (2.5%) died within 30 days post-operatively. Twenty-two patients experienced severe adverse events. There were significant differences between the two groups regarding their serum albumin and creatinine concentrations, ejection fraction, and hospitalization, cardiopulmonary bypass, aortic cross-clamp, intensive care unit (ICU), and ventilation times (all p < 0.05). The bypass time, aortic cross-clamp time, and ICU time were identified as prognostic factors for severe adverse events. Conclusion: Echocardiography is an important diagnostic method for IE, and repeated tests might improve the sensitivity of diagnosis. Cardiac surgery seems to be an effective treatment for IE. Patient screening and reducing the operative time may improve the prognosis for patients who undergo surgical treatment for IE.

Making the Cut: Perspectives on the Surgical Management of Infective Endocarditis Among People Who Use Intravenous Drugs

In this article we review the perspectives in the literature around surgical treatment for infective endocarditis (IE) in people who use intravenous drugs (PUID). PUID are at increased risk for IE; however, controversy exists regarding how to best manage these patients. We explore the outcomes for surgical treatment in PUID with IE, contrasting these with patients with IE who do not use drugs. We describe some of the perspectives in the literature around second valve replacement for PUID with IE, arguing that moralistic arguments are not on the basis of evidence and perpetuate the stigma experienced by PUID who seek treatment for IE. Finally, we explore the role of substance use interventions in the treatment of PUID with IE, and advocate for further evidence. PUID with IE are a highly stigmatized patient subgroup for whom best practice management strategies are not always implemented, emphasizing the need for further research and advocacy.

Daptomycin-Containing Regimens for Treatment of Gram-Positive Endocarditis

Background: Infective endocarditis (IE) is a severe infection and a leading cause of mortality and morbidity. In clinical practice, daptomycin is routinely used in IE for its favorable microbiological and pharmacological characteristics. Methods: A prospective study was conducted in a large tertiary-care hospital in Italy over an 8-year period (January 2010 - January 2018) on all patients with native- (NVE) or prosthetic-valve endocarditis (PVE) caused by gram-positive bacteria. Patients with NVE and PVE treated with regimens that included daptomycin at different dosages (daptomycin-containing regimens, DCR) were compared with those treated with non-DCR. The primary endpoints of the study were 30-day mortality and clinical treatment failure. Findings: During the study period, we analyzed 327 patients with gram-positive NVE (n=224, 68.8%) or PVE (n=103, 31.2%). Eighty-four (37.5%) NVE patients were treated with daptomycin, alone (59.9%) or with other antimicrobials. Most PVE patients (n=61, 58%) were treated with a DCR, which always consisted of daptomycin plus other drugs. Among PVE patients, treatment with a DCR was associated with lower 30-day mortality than treatment with a non-DCR (6.5% vs. 38%, p<0.001). Among NVE patients treated with DCRs, risk factors for 30-day mortality were streptococcal infections, persistent bacteremia, and standard-dose (4-6 mg/kg) rather than high-dose daptomycin therapy. Overall, surgical treatment of IE was associated with clinical success. Interpretation: Compared with non-DCRs, use of single- or multiple-drug DCRs is associated with lower 30-day mortality in PVE, but with higher 30-day mortality in NVE at approved doses and in the subgroup of streptococcal IE. Funding Statement: The authors state: No funding. Declaration of Interests: The authors state: None to declare. Ethics Approval Statement: The study was pre-approved by the local ethics committee and conducted in accordance with the principles of the Declaration of Helsinki.

Outcome for surgical treatment of infective endocarditis with periannular abscess

Surgical treatment of infective endocarditis (IE) with aortic periannular abscess (PA) is a challenging issue with high mortality and morbidity rate in the current era. The present study is to review the results of surgical treatment for IE-PA based on an anatomy-guided surgical procedure selection for either aortic valve replacement (AVR) or aortic root reconstruction (ARR). Patients with IE-PA received surgical treatment in National Taiwan University Hospital during the years 2001-2017 were retrospectively reviewed. The selection of surgical procedure was based on the intraoperative anatomical finding. The AVR group consisted of isolated AVR or AVR with patch repair if PA involved less than one cusp of the annulus. The ARR group included aortic root replacement if PA involved more than one cusp, causing commissural/sub-commissural destruction. In-hospital mortality and mid-term outcome and the risk factors were examined. In-hospital mortality was 13% in the AVR group (24 patients) and 25% in the ARR group (8 patients) (p=0.578). The composite adverse events (cardiac death, valve reoperation, or paravalvular leak) rate was 31% in the AVR group and 40% in the ARR group at one year; 48% in the AVR group and 40% in the ARR group at five years; 55% in the AVR group and 40% in the ARR group at ten years. Anatomy-guided surgical procedure selection for IE-PA is feasible. With the appropriate selection, ARR may be associated with fewer adverse events in mid-term follow-up. Careful intraoperative judgment and management and long-term follow-up are warranted for these patients.

Surgical management of infective endocarditis: risk factors affecting early outcome

Objective To evaluate the risk factors affecting the early outcome of surgical treatment of infective endocarditis (IE). Background IE represents a series of clinical conditions with high in-hospital mortality, so early diagnosis and treatment can improve outcomes. Diagnosis depends on constant history and classic manifestations like sustained bacteremia or fungemia or active valvulitis. IE is a medical-surgical disease in which surgical treatment is a part of the therapeutic process rather than a result of the failure of medical treatment. Patients and methods A prospective cohort study was conducted on 50 consecutive patients diagnosed with definite IE and underwent cardiac surgery after being admitted to the Cardiothoracic Surgical Department, National Heart Institute, Giza, Egypt, during the period from December 2015 till March 2017. Preoperative, intraoperative, and postoperative data as potential predictors of mortality were tested. Results Our results showed that rheumatic heart disease was the most common underlying cardiac disease. Native valve endocarditis was present in 31 (62%) and prosthetic valve endocarditis in 19 (38%) patients. Mean Euro SCORE II was 5.71%. The hospital mortality was 22%, whereas the 6-month mortality was 10%. Congestive heart failure, embolization, and periannular extension of infection are the most powerful predictors of hospital mortality and also 6-month mortality. Conclusion Surgery for IE continues to be challenging. Euro SCORE II has a good discrimination ability to predict in-hospital mortality in IE surgery. Satisfactory results can be obtained with valve repair in IE.

Early surgery with aggressive surgical approach to improve 6-month outcomes in patients with active infective endocarditis: contribution of cerebral preoperative magnetic resonance imaging.

We investigated the hypothesis that early surgery for infective endocarditis (IE) attenuates the rate of death or embolic events and does not increase the rate of relapse or postoperative valvular dysfunction (PVD) at 6 months. 21 consecutive patients who underwent surgical treatment of IE were prospectively included. We assessed 6-month postoperative clinical outcomes by comparing early surgery (Group E, surgery within 72h) and conventional treatment (Group C). Nine patients (43%) were assigned to Group E based on a combination of preoperative evaluation parameters, including the findings of cerebral magnetic resonance imaging (MRI), which was performed in all patients with left-sided IE. Six surgical plans (5 advancements and 1 postponement) were modified by routine MRI. Although preoperative echocardiography did not confirm all annular invasions, the rate of periannular infection, which was treated by pericardial annular patch plasty (56%) in patients with native-valve IE, was higher in Group E than C (P = 0.006). Early surgery based on MRI findings resulted in no postoperative embolic events or cerebral bleeding. The 6-month mortality rate was 0% in both groups, although the calculated 6-month IE mortality rate was 49.2 ± 25% and 28.8 ± 18%, respectively. No recurrence of IE or PVD occurred in Group E. The 6-month rate of freedom from composite events was 100% in Group E. Aggressive treatment (periannular resection and disuse of a prosthetic annuloplasty ring) and optimal antibiotic therapy based on intraoperative microorganisms, even in patients who underwent early surgery, reduced the 6-month relapse and PVD rates.

Invited Commentary

Invited Commentary

A Contemporary Strategy for the Surgical Treatment of Destructive Forms of Infective Endocarditis

Introduction. Despite recent achievements in medicine, many issues in the diagnosis and treatment of infective endocarditis (IE) remain outstanding. This is mainly due both to an increase in the incidence and changes in the clinical picture of this nosology. An important factor here is the continuing presence of existing principles governing the approach to the surgical treatment of infective endocarditis, including prosthetic endocarditis.Objective: to evaluate the effectiveness of an integrated approach to the treatment of infective endocarditis in patients with valvular heart disease on the basis of 37 years of experience.Materials and methods. An analysis of the surgical treatment of 1097 patients with infectious lesions of the valvular heart apparatus was carried out. The mean age of the sample was 35.1 ± 9.7 years (from 4 months to 68 years); 67.2 % were men, while women made up 32.8 %. Additionally, 122 patients had infectious lesions affecting 2 or more valves. In 109 cases, valvular prosthetic endocarditis was diagnosed; in 37 patients, IE was detected against the background of congenital heart defects. 99 patients had perianular abscesses. Of all surgical interventions carried out, 18 were repeated, including those with non-valvular congenital heart defects.Results and discussion. Overall hospital mortality was 4.3 % (47 patients). In patients with IE complicated by a congenital heart defect (CHD), mortality was 14.7 %; with endocarditis of mechanical heart valves — 13.2 %; in drug-dependent patients — 4.5 %; with infectious destruction of native heart valves — 2.8 %; in patients with a background of electrodeinduced endocarditis, no deaths during hospitalisation were observed.Conclusions. The effectiveness of surgical intervention of infective endocarditis can reach 85.4 %. When supplemented with pathogenetic and etiotropic therapy, surgical correction of affected heart structures contributes to the rapid and reliable sanitation of all infection foci, as well as to a reduction in multiple organ failure. Timely surgery significantly reduces the degree of heart failure and improves the NYHA functional class. In the long term, reconstructive interventions contribute to a better heart recovery than prosthetic operations. It should be noted that the proposed treatment approach for this group of patients creates conditions for adequate labour and social rehabilitation in a distant postoperative period.

Surgical Management of Patients with Infective Endocarditis : A Systematic Review

Introduction: Replacement of the heart valves has been spread recently with wide variety of types and surgical techniques. There is, however, no consensus regarding the best type and/or techniques of the surgical treatment of infective endocarditis. Objective: The aim of the systematic review was to evaluate the evidence-based published articles dealt with different types of valve replacement in the management of infective endocarditis. Methods: An electronic search was conducted on the electronic search engine PubMed including Medline. Keywords used for this research included; infective endocarditis, bacterial endocarditis, surgery, valve replacement, outcomes, timing, mortality, relapse and death. Results: Among the screened articles there were a total of 11 articles included for this systematic review. Out of which, there were 6 prospective randomized clinical trials and the remaining 5 studies were prospective clinical trials without randomization. Conclusion: From the findings of this review it can be concluded that the infective endocarditis is still a life-threatening disease requires more efforts for prevention and management. Surgical treatment of infective endocarditis with prosthetic or biologic valves does not differ significantly in outcomes or complications with a little bit higher in complications when using biologic valves.

Surgical treatment of infective endocarditis of the aortic valve complicated by aortic root abscess and false aneurysm

Surgical treatment of infective endocarditis of the aortic valve complicated by aortic root abscess and false aneurysm

Clinical Characteristics and Surgical Treatment of Infective Endocarditis With Bicuspid Aortic Valve.

This study aimed to evaluate the clinical characteristics and surgical treatment of bicuspid aortic valve (BAV) infective endocarditis (IE) compared with tricuspid aortic valve (TAV) IE in China.The relevant pre-, intra- and post-operative materials of all IE patients undergoing cardiac surgery in our center between January 2003 and December 2012 were investigated and analyzed retrospectively.From January 2003 to December 2012, 345 consecutive IE patients received surgery in our center. A total of 171 native aortic valve IE patients were enrolled in this study, accounting for 49.6% of the total population. Among these 171 IE patients, 29.8% (n = 51) were BAV, and the remaining (n = 120) were TAV. There was a strong male predominance (92.2% versus 70.8%, P = 0.002) and a higher frequency of aortic perivalvular abscess (45.1% versus 18.3%, P < 0.001) in the BAV IE group compared with the TAV IE group. In multivariate analysis, BAV was the only independent predictor associated with an increased risk of aortic perivalvular abscess (OR = 4.365, 95% CI 1.30-14.65, P = 0.017). Six patients died postoperatively and no significant difference was found about in-hospital mortality between the BAV IE group and TAV IE group (2.0% versus 4.2%, P = 0.793).BAV is common in patients with confirmed aortic valve IE. BAV IE patients have a significantly increased risk of perivalvular abscess. Prompt diagnosis and timely surgery for BAV IE patients might be needed to prevent the formation and extension of perivalvular abscess.

大動脈弁，僧帽弁，肺動脈弁の3尖に感染の及んだ心室中隔欠損症を伴う感染性心内膜炎の1治験例

症例は46歳の男性で，幼少時より心室中隔欠損症（VSD）を指摘されていた．発熱，全身倦怠感を主訴に入院，心エコー検査で，大動脈弁，僧帽弁，肺動脈弁にそれぞれ10 mm以上の可動性を有する疣贅を認め，高度僧帽弁閉鎖不全症，中等度大動脈弁閉鎖不全症および肺動脈弁閉鎖不全症を認めた．緊急手術にて，大動脈弁置換術，僧帽弁置換術，VSD閉鎖術，グルタールアルデヒド処理自己心膜による肺動脈弁形成術を施行した．感染性心内膜炎は通常1つの弁に感染巣を形成する場合が多く，3弁以上に感染が波及することは比較的稀である．また3弁に及ぶ感染性心内膜炎で，大動脈弁，僧帽弁，肺動脈弁に感染をきたすものは少ない．また両心系に及ぶ感染性心内膜炎は心内シャントを有する先天性疾患患者に多く，本症例でもsubarterial-infundibular型心室中隔欠損症があり，欠損孔を通じて感染の拡大が考えられた．早期の外科的介入が感染と心不全コントロールに有用であった．