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

Abstract

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 6 months.

Management of Septic emboli in patients with infectious endocarditis

“…Current indications for splenectomy in patients with splenic emboli include splenic infarction or abscess larger than 2 cm, persistent sepsis symptoms, peripheral lesions, and a ruptured spleen . However, the timing of splenectomy is controversial . Splenectomy concomitant with cardiac surgery increases the duration of surgery and operative insult .…”

“…Patients with severe illness (shortness of breath, cough, weight loss, enlarged spleen, and a heart murmur) underwent early splenectomy and others had splenectomy with or following their valve surgery. However, there is no consensus about optimal timing and order of operations . IIA was confirmed by brain angiography and neurological intervention was performed before valve surgery for patients with ruptured, symptomatic, or enlarging IIA.…”

“…Only small case series regarding the efficacy and safety of neurosurgical interventions in IE patients have been reported . Several studies have reported risk factors for splenic SE, yet no prior study has predicted the need for splenectomy. Management of splenic abscess in IE remains controversial.…”

2015 ESC Guidelines for the management of infective endocarditis

“…Rzadziej splenektomię i zabieg kardiochirurgiczny wykonuje się jednocześnie. U pacjentów obciążonych wysokim ryzykiem operacyjnym alternatywę może stanowić drenaż przezskórny [274,275].…”

Splenectomy and Valve Replacement in Patients With Infective Endocarditis and Splenic Abscesses

“…Currently there are two proposed therapeutic approaches, one suggesting valve replacement followed by antibiotic therapy associated with close follow-up with CT scans of the abdomen, and the other favoring both splenectomy and valve operation either simultaneously or in a staged fashion [1,2,4]. It must, however, be considered that splenic abscesses may contribute to dissemination of the infection, being prone to sudden rupture, which at times may be fatal [1,2,5]. Robinson et al [6] observed 100% mortality at follow-up in patients with IE without splenectomy and 82% survival in those with splenectomy, emphasizing that removal of the spleen has a positive impact on reducing the risk of graft infection.…”