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Article: Infective endocarditis 2006: indications for surgery.

O'Gara, Patrick T

Transactions of the American Clinical and Climatological Association

2008 Volume 118, Page(s) 187–198

Abstract: ... Surgery in the acute phase is indicated chiefly for the treatment of heart failure, the eradication ... of intra-cardiac abscess or the management of antibiotic-resistant infection. Surgery for the prevention ... Infective endocarditis has challenged clinicians for centuries. Despite recent advances ...

Abstract	Infective endocarditis has challenged clinicians for centuries. Despite recent advances in diagnosis and therapy, the risks of major complications and death in many clinical situations remain unacceptably high, related in part to patient demographics and the changing microbiology of the disease. Surgery in the acute phase is indicated chiefly for the treatment of heart failure, the eradication of intra-cardiac abscess or the management of antibiotic-resistant infection. Surgery for the prevention of systemic embolization in patients with large vegetations is an evolving area of clinical practice that will merit continued scrutiny as surgical repair techniques, anesthetic management and perioperative patient outcomes steadily improve in high volume centers. The strength of treatment recommendations is limited by the absence of prospective, randomized controlled trial data, a limitation that applies broadly to the field of valvular heart disease. Ongoing multi-center registry efforts will help fill several important knowledge gaps.
MeSH term(s)	Clinical Trials as Topic ; Decision Making ; Drug Resistance, Microbial ; Endocarditis/diagnosis ; Endocarditis/epidemiology ; Endocarditis/mortality ; Endocarditis/surgery ; Heart Valve Prosthesis/adverse effects ; Humans ; Prognosis
Language	English
Publishing date	2008-05-07
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	603823-2
ISSN	0065-7778
ISSN	0065-7778
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Article ; Online: Cardiac surgery in infective endocarditis and predictors of in-hospital mortality.

Guiomar, Neusa / Vaz-da-Silva, M / Mbala, D / Sousa-Pinto, B / Monteiro, J P / Ponce, P / Carneiro, F / M Guerra / Neves, F / Ferraz, R / Rijo, D / Teixeira, M / Vouga, L / Braga, P

Revista portuguesa de cardiologia

2020 Volume 39, Issue 3, Page(s) 137–149

Abstract: ... characterization of patients undergoing cardiac surgery for IE and to identify factors that predict ... valves in 10.3%. Staphylococcus spp. (31.0%) were the most frequent etiological agents. Cardiac surgery ... although without statistical significance, emergent surgery.: Conclusions: There is a need for better indicators to enable ...

Title translation	Cirurgia cardíaca na endocardite infeciosa e preditores da mortalidade intra‐hospitalar.
Abstract	Introduction: Infective endocarditis (IE) is a serious disease with significant in-hospital mortality (15-30%) despite advances in medical and surgical therapy. Aims: To perform a clinical characterization of patients undergoing cardiac surgery for IE and to identify factors that predict in-hospital mortality. Methods: We retrospectively analyzed 145 patients with IE admitted between January 2006 and October 2017. Results: The median age was 72 years. IE was acquired mainly in the community (69%), and involved the native aortic valve in 54% of patients, biological prosthetic valves in 22.1% and mechanical valves in 10.3%. Staphylococcus spp. (31.0%) were the most frequent etiological agents. Cardiac surgery was emergent in 29 patients, urgent in 108, and elective in eight. The main indications were heart failure (57.9%), large vegetations (20%), systemic embolism (17.2%) and valve dysfunction (15.2%). Overall, biological valves were implanted in 62.1% of patients and mechanical valves in 37.2%. A total of 19 patients (13.1%) died. Predictors of mortality were preoperative atrial fibrillation and lower left ventricular ejection fraction, postoperative severe valve regurgitation associated with cardiogenic shock, sepsis, septic shock associated with cardiogenic shock, cardiac tamponade, need for renal replacement therapy and, although without statistical significance, emergent surgery. Conclusions: There is a need for better indicators to enable early identification of surgical candidates for IE, implementation of a heart team, and better surgical strategies, including more rapid intervention, more specific postoperative care, and optimal antibiotic therapy.
MeSH term(s)	Aged ; Aged, 80 and over ; Aortic Valve/microbiology ; Aortic Valve/pathology ; Aortic Valve/surgery ; Atrial Fibrillation/epidemiology ; Atrial Fibrillation/etiology ; Atrial Fibrillation/mortality ; Cardiac Surgical Procedures/methods ; Cardiac Surgical Procedures/statistics & numerical data ; Case-Control Studies ; Endocarditis/microbiology ; Endocarditis/mortality ; Endocarditis/pathology ; Endocarditis/surgery ; Female ; Heart Failure/epidemiology ; Heart Failure/mortality ; Heart Failure/surgery ; Heart Valve Prosthesis/adverse effects ; Heart Valve Prosthesis/statistics & numerical data ; Hospital Mortality/trends ; Humans ; Male ; Middle Aged ; Predictive Value of Tests ; Prognosis ; Prosthesis-Related Infections/complications ; Retrospective Studies ; Shock, Cardiogenic/epidemiology ; Shock, Cardiogenic/etiology ; Shock, Cardiogenic/mortality ; Staphylococcus/isolation & purification ; Ventricular Dysfunction, Left/epidemiology ; Ventricular Dysfunction, Left/etiology ; Ventricular Dysfunction, Left/mortality
Language	Portuguese
Publishing date	2020-04-25
Publishing country	Spain
Document type	Journal Article
ZDB-ID	2646972-8
ISSN	2174-2049 ; 2174-2049
ISSN (online)	2174-2049
ISSN	2174-2049
DOI	10.1016/j.repc.2019.08.009
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Article: Infective endocarditis: diagnosis and management.

Haldar, Saptarsi M / O'Gara, Patrick T

Nature clinical practice. Cardiovascular medicine

2006 Volume 3, Issue 6, Page(s) 310–317

Abstract: Despite advances in antimicrobial therapy, diagnostic imaging and cardiac surgery ... by clinical data. Deciding whether to undertake cardiac surgery for the treatment of IE can be extremely ... mitral regurgitation, or perivalvular extension of infection. The timing of surgery following ...

Abstract	Despite advances in antimicrobial therapy, diagnostic imaging and cardiac surgery, infective endocarditis (IE) remains challenging clinically and is associated with high morbidity and mortality. Diagnosis relies on several factors: initial clinical suspicion, microbiological data and echocardiographic findings. The use of an integrated diagnostic schema, such as the modified Duke criteria, is useful. Transthoracic or transesophageal echocardiography should be performed promptly for all suspected IE cases. Although the choice of investigation might be influenced by availability, the approach to imaging should be tailored to the individual's clinical situation. Promptly administered intravenous antimicrobial therapy is essential, while the use of antiplatelet or antithrombin therapy to prevent embolic complications is not supported by clinical data. Deciding whether to undertake cardiac surgery for the treatment of IE can be extremely difficult. The principal indications are the development of heart failure from acute, severe aortic or mitral regurgitation, or perivalvular extension of infection. The timing of surgery following central nervous system embolization is problematic because of the risk of hemorrhagic transformation. Prophylactic surgery to prevent embolization is currently advocated only for the management of large, mobile vegetations, when undertaken at centers performing high volumes of heart valve surgery. In this review, we describe diagnostic approaches for IE, particularly echocardiography, and provide recommendations for treatment, paying particular attention to surgery in the acute setting.
MeSH term(s)	Anti-Infective Agents/therapeutic use ; Cardiac Surgical Procedures ; Echocardiography ; Endocarditis, Bacterial/diagnosis ; Endocarditis, Bacterial/drug therapy ; Endocarditis, Bacterial/surgery ; Fibrinolytic Agents/therapeutic use ; Humans ; Platelet Aggregation Inhibitors/therapeutic use ; Practice Guidelines as Topic ; Prognosis ; Secondary Prevention
Chemical Substances	Anti-Infective Agents ; Fibrinolytic Agents ; Platelet Aggregation Inhibitors
Language	English
Publishing date	2006-06
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2177710-X
ISSN	1743-4297
ISSN	1743-4297
DOI	10.1038/ncpcardio0535
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Article: [Effectiveness of combined treatment of infective endocarditis].

Nikolaevskiĭ, E N / Khubulava, G G / Osadchuk, M A

Klinicheskaia meditsina

2006 Volume 84, Issue 1, Page(s) 57–61

Abstract: ... infective endocarditis (IE). Ten-year experience in clinical diagnostics of 240 patients with acute, subacute, and ... pathogenetic, and symptomatic therapy, as well as extracorporal hemocorrection and cardiosurgery. Analysis ... of the results of surgical treatment of 140 IE patients allowed development of indications for valve prosthesis. ...

Abstract	The purpose of the study was to develop and perfect complex therapy of modern infective endocarditis (IE). Ten-year experience in clinical diagnostics of 240 patients with acute, subacute, and lingering IE was summarized; the effectiveness of their treatment was evaluated. The features of modern IE were acute and subacute course of the disease with the involvement of aortal (37.8% of cases), tricuspid (16.8%), mitral (15.2%) valve, and septicemia, caused by highly virulent microflora (staphylococci--51% of cases; gram-negative bacteria--13%; fungi--5%). The clinical manifestations of modern IE included toxic infectious syndrome (24% of cases), heart failure (21%), symptoms of complications (16%), central hemodynamics disturbances (12%), and splenomegaly (8%). The treatment included antibacterial, pathogenetic, and symptomatic therapy, as well as extracorporal hemocorrection and cardiosurgery. Analysis of the results of surgical treatment of 140 IE patients allowed development of indications for valve prosthesis.
MeSH term(s)	Adult ; Anti-Bacterial Agents/therapeutic use ; Cephalosporins/therapeutic use ; Combined Modality Therapy ; Endocarditis, Bacterial/drug therapy ; Endocarditis, Bacterial/mortality ; Endocarditis, Bacterial/surgery ; Female ; Humans ; Male ; Survival Rate
Chemical Substances	Anti-Bacterial Agents ; Cephalosporins
Language	Russian
Publishing date	2006
Publishing country	Russia (Federation)
Document type	Clinical Trial ; English Abstract ; Journal Article
ZDB-ID	391034-9
ISSN	0023-2149
ISSN	0023-2149
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Article ; Online: Surgical treatment of infective valve endocarditis in children with congenital heart disease.

Karaci, Ali Riza / Aydemir, Numan Ali / Harmandar, Bugra / Sasmazel, Ahmet / Saritas, Turkay / Tuncel, Zeliha / Yekeler, Ibrahim

Journal of cardiac surgery

2012 Volume 27, Issue 1, Page(s) 93–98

Abstract: ... for infective valve endocarditis between 2006 and 2010 were included in the study. The aortic and mitral valves ... Seven consecutive children (five females, two males; mean age, 10.8 years) who underwent surgery ... term results of infective valve endocarditis in children with congenital heart disease.: Methods ...

Abstract	Objective: This study assesses surgical procedures, operative outcome, and early and intermediate-term results of infective valve endocarditis in children with congenital heart disease. Methods: Seven consecutive children (five females, two males; mean age, 10.8 years) who underwent surgery for infective valve endocarditis between 2006 and 2010 were included in the study. The aortic and mitral valves were affected in two and tricuspid in five patients. Indications for operation included cardiac failure due to atrioventricular septal rupture, severe tricuspid valve insufficiency, and septic embolization in one, moderate valvular dysfunction with vegetations in three (two tricuspid, one mitral), and severe valvular dysfunction with vegetations in the other three patients (two tricuspid, one mitral). The pathological microorganism was identified in five patients. Tricuspid valve repair was performed with ventricular septal defect (VSD) closure in five patients. Two patients required mitral valve repair including one with additional aortic valve replacement. Results: There were no operative deaths. Actuarial freedom from recurrent infection at one and three years was 100%. Early echocardiographic follow-up showed four patients to have mild atrioventricular valve regurgitation (three tricuspid and one mitral) and three had no valvular regurgitation. No leakage from the VSD closure or any valvular stenosis was detected postoperatively. Conclusions: Mitral and tricuspid valve repairs can be performed with low morbidity/mortality rates and satisfactory intermediate-term results in children with infective valve endocarditis.
MeSH term(s)	Adolescent ; Aortic Valve/abnormalities ; Cardiopulmonary Bypass ; Child ; Endocarditis, Bacterial/complications ; Endocarditis, Bacterial/diagnosis ; Endocarditis, Bacterial/surgery ; Female ; Follow-Up Studies ; Heart Defects, Congenital/complications ; Heart Septal Defects, Ventricular/complications ; Heart Septal Defects, Ventricular/surgery ; Heart Valve Diseases/complications ; Heart Valve Diseases/diagnosis ; Heart Valve Diseases/surgery ; Heart Valve Prosthesis Implantation ; Humans ; Male ; Mitral Valve/microbiology ; Mitral Valve/surgery ; Retrospective Studies ; Staphylococcal Infections/complications ; Staphylococcal Infections/diagnosis ; Staphylococcal Infections/surgery ; Sternotomy ; Streptococcal Infections/complications ; Streptococcal Infections/diagnosis ; Streptococcal Infections/surgery ; Streptococcus oralis/isolation & purification ; Treatment Outcome ; Tricuspid Valve/microbiology ; Tricuspid Valve/surgery ; Viridans Streptococci/isolation & purification
Language	English
Publishing date	2012-01
Publishing country	United States
Document type	Evaluation Studies ; Journal Article
ZDB-ID	639059-6
ISSN	1540-8191 ; 0886-0440
ISSN (online)	1540-8191
ISSN	0886-0440
DOI	10.1111/j.1540-8191.2011.01339.x
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Article ; Online: Impact of early surgery on embolic events in patients with infective endocarditis.

Kim, Dae-Hee / Kang, Duk-Hyun / Lee, Myung-Zoon / Yun, Sung-Cheol / Kim, Yong-Jin / Song, Jong-Min / Song, Jae-Kwan / Lee, Jae-Won / Sohn, Dae-Won

Circulation

2010 Volume 122, Issue 11 Suppl, Page(s) S17–22

Abstract: ... included if they had a left-sided native valve endocarditis with vegetation. The choice of early surgery or ... in IE patients with embolic indications only.: Methods and results: From 1998 to 2006 ... remain controversial. We sought to compare clinical outcomes of early surgery with conventional treatment ...

Abstract	Background: Surgical indications to prevent systemic embolism in infective endocarditis (IE) remain controversial. We sought to compare clinical outcomes of early surgery with conventional treatment in IE patients with embolic indications only. Methods and results: From 1998 to 2006, we prospectively enrolled 132 consecutive patients (86 men; age, 49±17 years) with definite IE. Patients were included if they had a left-sided native valve endocarditis with vegetation. The choice of early surgery or conventional treatment was at the discretion of attending physician. Early surgery was performed on 64 patients (OP group) within 7 days of diagnosis, and conventional management was chosen for 68 patients (CONV group). The OP group had larger vegetations and a higher percentage of patients with severe valvular disease (88% versus 62%, P=0.001). During initial hospitalization, there were no embolic events and 2 in-hospital deaths in the OP group and 14 embolic events and 2 in-hospital deaths in the CONV group. During a median follow-up of 1402 days, there were 2 cardiovascular deaths, 2 embolic events, and 1 recurrence of IE in the CONV group, and 1 cardiovascular death and 2 embolic events in the OP group. The 5-year event-free survival rate was significantly higher in the OP group (93±3%) than in the CONV group (73±5%, P=0.0016). For 44 propensity score-matched pairs, the OP group had a lower event rate (hazard ratio, 0.18; P=0.007). Conclusions: Compared with conventional treatment, an early surgery strategy is associated with improved clinical outcomes by effectively decreasing systemic embolism in patients with IE.
MeSH term(s)	Adult ; Aged ; Disease-Free Survival ; Embolism/etiology ; Embolism/mortality ; Endocarditis/mortality ; Endocarditis/surgery ; Female ; Hospital Mortality ; Humans ; Male ; Middle Aged ; Prospective Studies ; Registries ; Retrospective Studies ; Survival Rate ; Time Factors
Language	English
Publishing date	2010-09-14
Publishing country	United States
Document type	Comparative Study ; Journal Article
ZDB-ID	80099-5
ISSN	1524-4539 ; 0009-7322 ; 0069-4193 ; 0065-8499
ISSN (online)	1524-4539
ISSN	0009-7322 ; 0069-4193 ; 0065-8499
DOI	10.1161/CIRCULATIONAHA.109.927665
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Article ; Online: Dramatic reduction in infective endocarditis-related mortality with a management-based approach.

Botelho-Nevers, Elisabeth / Thuny, Franck / Casalta, Jean Paul / Richet, Hervé / Gouriet, Frédérique / Collart, Frédéric / Riberi, Alberto / Habib, Gilbert / Raoult, Didier

Archives of internal medicine

2009 Volume 169, Issue 14, Page(s) 1290–1298

Abstract: Background: Despite improvements in medical and surgical therapy, infective endocarditis (IE) is ... that included 333 consecutive patients treated for IE at a referral center from 1991 to 2006, which was divided ... period 2 (2002-2006), after implementation of our protocol (n = 160). Our protocol was created ...

Abstract	Background: Despite improvements in medical and surgical therapy, infective endocarditis (IE) is still associated with a severe prognosis and remains a therapeutic challenge. We aimed to evaluate the impact of a standardized diagnostic and therapeutic protocol on mortality and to correlate the outcome with compliance with our management-based protocol. Methods: We conducted an observational before-after study that included 333 consecutive patients treated for IE at a referral center from 1991 to 2006, which was divided into 2 periods: period 1 (1991-2001), before implementation of our therapeutic protocol (n = 173), and period 2 (2002-2006), after implementation of our protocol (n = 160). Our protocol was created by a multidisciplinary task force including a sampling of biological specimens, the use of only 4 antimicrobial agents, a standardized duration of treatment, standardized surgical indications, and 1 year of close follow-up. Because our protocol was based on a local consensus by physicians and surgeons, it was not possible to randomize the study. Results: The 1-year mortality significantly decreased from 18.5% during period 1 to 8.2% during period 2 (hazard ratio, 0.41; 95% confidence interval, 0.21-0.79 [P = .008]). After multivariable analysis, the management during period 2 remained a strong protective factor (adjusted hazard ratio, 0.26; 95% confidence interval, 0.09-0.76 [P = .01]). During period 2, we observed a statistically significantly better compliance in antimicrobial therapy and fewer cases of renal failure. Deaths by embolic events and multiple organ failure syndrome also significantly decreased during period 2. Conclusion: A dramatic reduction in mortality was observed during this study, suggesting that a management-based approach has a significant impact on IE outcome.
MeSH term(s)	Adult ; Aged ; Clinical Protocols ; Endocarditis/drug therapy ; Endocarditis/mortality ; Endocarditis/surgery ; Evidence-Based Medicine ; Female ; France/epidemiology ; Humans ; Male ; Middle Aged
Language	English
Publishing date	2009-07-27
Publishing country	United States
Document type	Clinical Trial ; Journal Article
ZDB-ID	211575-x
ISSN	1538-3679 ; 0003-9926 ; 0888-2479 ; 0730-188X
ISSN (online)	1538-3679
ISSN	0003-9926 ; 0888-2479 ; 0730-188X
DOI	10.1001/archinternmed.2009.192
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Article: Infective endocarditis in intravenous drug abusers: patterns of presentation and long-term outcomes of surgical treatment.

Carozza, Antonio / De Santo, Luca Salvatore / Romano, Gianpaolo / Della Corte, Alessandro / Ursomando, Fabio / Scardone, Michelangelo / Caianiello, Giuseppe / Cotrufo, Maurizio

The Journal of heart valve disease

2006 Volume 15, Issue 1, Page(s) 125–131

Abstract: ... left heart involvement (61.5%), a severe clinical course, and a need for surgery in the active phase ... than in non-IVDA cases (p = 0.001), left-sided endocarditis prevailed in both groups. In addition ... Background and aim of the study: Few data exist on infective endocarditis (IE) in intravenous drug ...

Abstract	Background and aim of the study: Few data exist on infective endocarditis (IE) in intravenous drug abuse (IVDA) patients. In particular, clinical features, site of involvement and bacteriologic findings are controversial. Little is also known on the results of surgical treatment and on the long-term prognosis. Methods: The clinical and microbiological characteristics of IE in a series of 39 IVDA patients were retrospectively assessed and compared to those in 85 non-IVDA patients with a likely similar life expectancy. The total follow up of patients was 717.6 patient-years (119.9 pt-yr for IVDA, 597.7 pt-yr for non-IVDA). Results: Although tricuspid involvement was significantly more frequent in IVDA cases than in non-IVDA cases (p = 0.001), left-sided endocarditis prevailed in both groups. In addition to Staphylococcus aureus (51.3%), Staph. epidermidis (15.4%) and streptococcal spp. (23.1%) were emerging pathogens in IVDA cases. A worse cardiac function (p < 0.002) and a higher rate of embolism (p = 0.04) characterized the preoperative status of IVDA patients. No difference was observed as to indications, emergency procedures and pathologic findings. Hospital and long-term survival did not significantly differ between the two groups. The rate of recurrence was higher in IVDA cases; this difference was mostly accounted for by early postoperative events. Conclusion: A new pattern of IE in IVDA is emerging, characterized by more frequent left heart involvement (61.5%), a severe clinical course, and a need for surgery in the active phase. Staph. epidermidis and streptococci are emerging pathogens. Drug abuse does not affect postoperative prognosis when an aggressive surgical attitude is combined with prolonged medical therapy. Higher rates of early recurrence are expected during the follow up period.
MeSH term(s)	Adult ; Aortic Valve/microbiology ; Aortic Valve/surgery ; Endocarditis, Bacterial/etiology ; Endocarditis, Bacterial/microbiology ; Endocarditis, Bacterial/surgery ; Endocarditis, Bacterial/therapy ; Female ; Follow-Up Studies ; Gram-Negative Bacterial Infections/etiology ; Gram-Positive Bacterial Infections/etiology ; Heart Valve Diseases/etiology ; Heart Valve Diseases/microbiology ; Heart Valve Diseases/surgery ; Heart Valve Diseases/therapy ; Heart Valve Prosthesis Implantation/adverse effects ; Hospital Mortality ; Humans ; Male ; Mitral Valve/microbiology ; Mitral Valve/surgery ; Recurrence ; Retrospective Studies ; Substance Abuse, Intravenous/complications ; Survival Analysis ; Time Factors ; Treatment Outcome ; Tricuspid Valve/microbiology ; Tricuspid Valve/surgery
Language	English
Publishing date	2006-01
Publishing country	England
Document type	Comparative Study ; Journal Article
ZDB-ID	1205265-6
ISSN	2053-2644 ; 0966-8519
ISSN (online)	2053-2644
ISSN	0966-8519
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Article ; Online: Timing chirurgico nell’endocardite infettiva valvolare.

Di Mauro, Michele / Actis Dato, Guglielmo / Sponga, Sandro / Lorusso, Roberto

Giornale italiano di cardiologia (2006)

2020 Volume 21, Issue 11, Page(s) 890–895

Abstract: ... Heart valve replacement; Heart valve surgery; Infective endocarditis; Timing of surgery. ... and over the years there has been a more aggressive attitude, with earlier indications for surgery ... endocarditis with severe regurgitation, outflow obstruction, refractory acute pulmonary edema ...

Title translation	Timing of surgery in heart valve infective endocarditis.
Abstract	The prevalence of valvular infective endocarditis (IE) is increasing and is burdened by high mortality and morbidity. Despite the higher risk, the surgical approach is superior to medical therapy alone, and over the years there has been a more aggressive attitude, with earlier indications for surgery. This article aims to review the available literature and the American and European guidelines in order to summarize the most appropriate surgical timing for valvular IE. Although there are discrepancies between the guidelines, an emergent indication (<48 h) should be considered in patients with either native or prosthetic endocarditis with severe regurgitation, outflow obstruction, refractory acute pulmonary edema, cardiogenic shock, or large mobile vegetations (>15-20 mm). Patients with signs of heart failure, persistence of positive cultures for more than 48-72 h despite antibiotic therapy, and in the presence of paravalvular lesions, advanced atrioventricular block and vegetations >10 mm should be operated early (within a few days). If any micro-organisms are isolated, including fungi or multi-resistant organisms in native IE or staphylococci or gram-negative pathogens in prosthesis IE, a more watchful approach (within 2 weeks) should be evaluated. In the presence of large cerebral embolic strokes or cerebral hemorrhage, re-evaluation at 2 and 4 weeks, respectively, is more appropriate. A multidisciplinary approach, especially in the most complex cases, seems to improve the outcome.Key words. Heart valve dysfunction; Heart valve repair; Heart valve replacement; Heart valve surgery; Infective endocarditis; Timing of surgery.
MeSH term(s)	Anti-Bacterial Agents/therapeutic use ; Atrioventricular Block/diagnosis ; Endocarditis/microbiology ; Endocarditis/surgery ; Heart Failure/diagnosis ; Heart Valve Diseases/microbiology ; Heart Valve Diseases/surgery ; Heart Valve Prosthesis/microbiology ; Humans ; Practice Guidelines as Topic ; Time-to-Treatment
Chemical Substances	Anti-Bacterial Agents
Language	Italian
Publishing date	2020-10-19
Publishing country	Italy
Document type	Journal Article ; Review
ZDB-ID	2272414-X
ISSN	1972-6481 ; 1827-6806
ISSN (online)	1972-6481
ISSN	1827-6806
DOI	10.1714/3455.34443
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Article: Chirurgická lécba aktivní infekcní endokarditidy: 8leté zkusenosti.

Kolek, M / Brát, R

Casopis lekaru ceskych

2006 Volume 145, Issue 9, Page(s) 718–24; discussion 724–5

Abstract: ... endocarditis prevailed over the prosthetic ones--49 versus 8. Surgery was most often performed using ... of patients who had undergone surgery for active infective endocarditis was 15.8 %, 9 patients died. During ... indications for surgery according to actual guidelines of the Czech Society of Cardiology ...

Title translation	Surgical treatment of infective endocarditis: 8 year experience.
Abstract	Background: A retrospective study analysing effects of surgical treatment of active infective endocarditis was performed in our centre between January 1998 and December 2005. Methods and results: 57 consecutive patients with infective endocarditis underwent surgical intervention in active phase of infection (fulfilment of Durack diagnostic criteria, persisting elevation CRP at the time of cardiac surgery, indications for surgery according to actual guidelines of the Czech Society of Cardiology). Male to female ratio was 38:19. The patients' mean age was 52.5 years without any significant differences among men and women. The most frequent causative agents were staphylococci--28.1 % and streptococci--19.3 %. 26 cases of aortic valve involvement were the most frequent, followed by 21 cases of mitral endocarditis, and 7 cases were both aortic and mitral valve endocarditis. 3 cases of tricuspid endocarditis were also observed. Native valve endocarditis prevailed over the prosthetic ones--49 versus 8. Surgery was most often performed using a mechanical prosthesis (45 cases), bioprostheses were implanted in 13 patients and 6 patients underwent mitral or tricuspid valve repair operation. In 1 patient, the procedure was complemented with mitral valve annuloplasty, and in 5 patients, the operation was completed with tricuspid annuloplasty--because of significant regurgitation of other aetiology. Coronary artery bypass surgery (at the same time) was necessary in 9 patients. Surgery was followed by a significant shift from classes III and IV to classes I and II of NYHA classification. Relapsing or recurrent endocarditis developed in 7 %. Thirty-day mortality of patients who had undergone surgery for active infective endocarditis was 15.8 %, 9 patients died. During follow up period 7 patients died, the overall mortality was 28.1 %. Survivors were followed up for 0.5-90 (median 40) months. Conclusions: Operation for active infective endocarditis carries a relatively higher mortality in comparison with elective surgery. Nevertheless, this is acceptable because the operation in active phase is enforced by life-threatening complications and it also reduces assumed mortality at conservative therapy. Our results are comparable with data from other studies.
MeSH term(s)	Bioprosthesis ; Endocarditis, Bacterial/microbiology ; Endocarditis, Bacterial/surgery ; Female ; Heart Valve Prosthesis Implantation ; Heart Valves/surgery ; Humans ; Male ; Middle Aged
Language	Czech
Publishing date	2006
Publishing country	Czech Republic
Document type	English Abstract ; Journal Article
ZDB-ID	413441-2
ISSN	1805-4420 ; 0008-7335
ISSN (online)	1805-4420
ISSN	0008-7335
Database	MEDical Literature Analysis and Retrieval System OnLINE

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