scholarly journals Medical management of infective endocarditis; Limitations and indication for surgery.

1985 ◽  
Vol 49 (5) ◽  
pp. 535-544 ◽  
Author(s):  
YOSHINORI KOGA ◽  
JUN-ICHI SHIBATA ◽  
TAKEHIKO YAMASAKI ◽  
YASUO OHKITA ◽  
HIRONORI TOSHIMA
Keyword(s):  
Infective Endocarditis ◽  
Medical Management ◽  
Indication For Surgery

Reassessment of vegetation size as a sole indication for surgery in left-sided infective endocarditis

2021 ◽  
Author(s):  
Gonzalo Cabezón ◽  
Javier López ◽  
Isidre Vilacosta ◽  
Carmen Sáez ◽  
Pablo Elpidio García-Granja ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Indication For Surgery

scholarly journals Infective endocarditis and neurologic events: indications and timing for surgical interventions

2020 ◽  
Vol 22 (Supplement_M) ◽  
pp. M19-M25
Author(s):  
Nikolaos Bonaros ◽  
Martin Czerny ◽  
Bettina Pfausler ◽  
Silvana Müller ◽  
Thomas Bartel ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Infective Endocarditis ◽  
Antibiotic Treatment ◽  
Current Literature ◽  
Lower Risk ◽  
Neurologic Injury ◽  
Indication For Surgery ◽  
Surgical Interventions ◽  
Infection Disease ◽  
Neurologic Event

Abstract A therapeutic dilemma arises when infective endocarditis (IE) is complicated by a neurologic event. Postponement of surgery up to 4 weeks is recommended by the guidelines, however, this negatively impacts outcomes in many patients with an urgent indication for surgery due to uncontrolled infection, disease progression, or haemodynamic deterioration. The current literature is ambiguous regarding the safety of cardiopulmonary bypass in patients with recent neurologic injury. Nevertheless, most publications demonstrate a lower risk for secondary haemorrhagic conversion of uncomplicated ischaemic lesions than the risk for recurrent embolism under antibiotic treatment. Here, we discuss the current literature regarding neurologic stroke complicating IE with an indication for surgery.

P2764Medical management of Staphylococcus aureus infective endocarditis: unexpectedly favourable outcomes in an aggressive disease

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C P Primus ◽  
M McCue ◽  
I Bvekerwa ◽  
E McGuire ◽  
K Wong ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Infective Endocarditis ◽  
Medical Management ◽  
Surgical Intervention ◽  
Electronic Device ◽  
Significant Proportion ◽  
Venous Catheter ◽  
Similar Proportion ◽  
Tissue Destruction ◽  
Improved Outcomes

Abstract Introduction Early surgical intervention (ESI) for infective endocarditis (IE) is associated with improved outcomes. Staphylococcus aureus endocarditis (SAE) is associated with particularly high rates of tissue destruction, morbidity and mortality. However, the question as to whether ESI is mandated in all SAE continues to be debated, in both native (NVE) and prosthetic (PVE) endocarditis. Methods Retrospective review of all IE cases presenting to our institution from October 2015 to January 2019. IE was diagnosed following imaging and microbiological protocols as per ESC guidance, and data were extracted for those with SAE. Patients with isolated cardiac implantable electronic device IE or bacteraemia secondary to indwelling long-term venous catheter infection were excluded (non-valvular IE). Results Valvular IE was diagnosed in 411 patients overall; NVE in 286 (69.6%) and PVE in 125 (30.4%). S aureus was isolated in 111 patients (28.1%), of whom 5 had a Methicillin-resistant strain. SAE was confirmed in a similar proportion of NVE and PVE cases [83/111 (74.8%) and 28/111 (25.2%), respectively]. Surgical intervention was mandated in 35/83 with NVE (42.2%) and 11/28 (39.3%) with PVE, lower than in our overall cohort (55.9% and 48.8%, respectively). In-hospital SAE mortality was 16.2% overall (18.4% medical vs 13.0% surgical), and contributes a significant proportion to overall mortality (29% to medical & 26% to surgical mortality). Figure 1 identifies the cause of death per mode of treatment, highlighting the aggressive nature of S aureus infection (abscess, disseminated infection and septic shock; n=8), the importance of advanced non-cardiac comorbidity precluding intervention (n=3) and ongoing intravenous drug use in those with PVE (n=4). However, medical management was successful in 57.8% (38/83) of NVE and 60.7% (17/28) of PVE cases, both in hospital and to a minimum follow-up of 3-months. Conclusion Staphylococcus aureus is virulent and highly pathogenic, driving severe sepsis and advanced tissue destruction in SAE. Despite this, medical management can be successful when following international guidance, but requires co-ordinated care driven by a multidisciplinary IE team at a cardiothoracic centre.

scholarly journals Infective endocarditis after transcatheter aortic valve implantation

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
C Arellano Serrano ◽  
J F Oteo Dominguez ◽  
A Garcia Touchard ◽  
J A Fernandez Diaz ◽  
M Del Trigo Espinosa ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Hospital Mortality ◽  
Systolic Pressure ◽  
Insulin Dependent Diabetes Mellitus ◽  
Dependent Diabetes Mellitus ◽  
Indication For Surgery ◽  
Coagulase Negative Staphylococci ◽  
Transcatheter Aortic Valve ◽  
Barthel Score ◽  
Esc Guidelines

Abstract Introduction Infective endocarditis (IE) is a potentially serious complication in patients with prosthetic heart valves. The objective of this study is to analyze and describe the incidence, baseline characteristics, risks factors and in-hospital evolution in IE after Transcatheter Aortic Valve Implantation (IE-TAVI). Methods All the TAVI implanted in our center since the beginning of the program have been included consecutively. Patients with a confirmed diagnosis of IE according to the “ESC Guidelines for the management of infective endocarditis” are identified and analyzed. Results 331 TAVI have been implanted in our center from June 2009 to February 2021. IE-TAVI incidence in our series is 2.7% (n=9 cases). In baseline analysis, we observed that insulin dependent diabetes mellitus, Barthel Score and Pulmonary systolic pressure >50mmHg are significantly associated with the appearance of IE-TAVI (TABLE 1). The most frequently microorganism is Enterococcus faecalis (44.4%; n=4) followed by Staphylococcus aureus (22.2%; n=2), Coagulase-negative staphylococci (22.2%; n=2) and Streptococcus viridans (11.1%; n=1). 77.8% of IE-TAVI (n=7) are Nosocomial IE or non-nosocomial healthcare-associated IE. 2 of them have been related to implantation (1 Enterococcus faecalis and 1 Coagulase-negative staphylococci) and 5 have been related to other interventions (2 after gastroscopy, 1 after percutaneous vascular intervention, 1 hemodialysis catheter infection and 2 unknown focus). 44.4% of IE-TAVI (n=4) were confirmed after performing Positron Emission Tomography (PET) scan. 3 cases (33.3%) were diagnosed with the initial Transthoracic Echocardiogram (TTE) and 2 cases (22.2%) were diagnosed after performing a Transesophageal Echocardiogram (TEE) (TABLE 2) 4 patients had an indication for surgery according to the ESC Guidelines (3 for persistent bacteremia and 1 for severe aortic regurgitation), but all were ruled out due to high surgical risk. Hospital mortality was 44.4% (n=4). The main predictor of hospital mortality was having an indication for surgery (p=0.028), which was present in 3 of the 4 deaths. The other death was due to digestive bleeding during hospitalization. Conclusions IE-TAVI is a serious disease with high in-hospital mortality. Insulin dependent diabetes mellitus, Barthel Score and Pulmonary systolic pressure >50mmHg are risk factors for IE-TAVI. PET-scan is the imaging test of choice when there were no echocardiographic findings. The main predictor of mortality is having an indication for surgery according to the ESC Guidelines. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Successful medical management of fungal infective endocarditis post VSD closure

2021 ◽  
Vol 24 (1) ◽  
pp. 95
Author(s):  
Banashree Mandal ◽  
KallaKrishna Prasad Gourav ◽  
AnandKumar Mishra ◽  
VKrishna Narayanan Nayanar
Keyword(s):  
Infective Endocarditis ◽  
Medical Management

Early versus late surgical intervention or medical management for infective endocarditis: a systematic review and meta-analysis

Heart ◽  
2016 ◽  
Vol 102 (12) ◽  
pp. 950-957 ◽  
Author(s):  
Mahesh Anantha Narayanan ◽  
Toufik Mahfood Haddad ◽  
Andre C Kalil ◽  
Arun Kanmanthareddy ◽  
Rakesh M Suri ◽  
...  
Keyword(s):  
Systematic Review ◽  
Infective Endocarditis ◽  
Medical Management ◽  
Surgical Intervention ◽  
Meta Analysis
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