Surgery for Infective Endocarditis

Endocarditis infecciosa: características clínicas, complicaciones y mortalidad en 506 pacientes y factores pronósticos de sobrevida a 10 años (1998-2008). Estudio cooperativo nacional en endocarditis infecciosa en Chile (ECNEI-2)

“…La cirugía se efectuó en 35,3% de los casos (Tabla 2). Las complicaciones intracardiacas y la IC secundaria fueron la primera causa de indicación quirúrgica y representan a más de la mitad de las indicaciones para este tipo de tratamiento [49][50][51][52][53][54] . En el Estudio ICE la cifra de intervenciones quirúrgicas llegó al 48,2% y la mortalidad global hospitalaria fue de 17,7%, lo que contrasta con la de nuestra serie de 26,1%.…”

“…A corto plazo en nuestro país nos parece que las indicaciones de cirugía precoz en esta entidad debieran aumentar y con ello posiblemente disminuiríamos esta mortalidad intrahospitalaria 5 , lo que sumado a un mayor porcentaje de hemocultivos positivos debieran optimizar el manejo antibiótico y médico-quirúrgico en la EI 52,53 , mejorando el pronóstico de estos pacientes. De ahí que no debe sorprender que como factores pronósticos de mortalidad encontramos fiebre persistente y fracaso del tratamiento antibiótico sin cirugía asociada en estudio multivariado para este período (Tabla 3), lo que se valida por curva ROC (Figura 4).…”

Infective Endocarditis, Heart and Beyond

“…In many cases where either patient fails to respond to medical treatment, manifests infectious embolism, has increasing heart failure, where vegetations are too many to eradicate or in cases where metallic valve is the vegetations' bed, surgical removal and valve replacement is needed to cure the patient [11].…”

Native and Prosthetic Aortic Valve Endocarditis

“…Surgery performed very early may improve survival in patients with the most severely complicated IE. However, a greater risk of relapses and postoperative valvular dysfunctions should be expected with very early surgery (Thuny et al, 2009 (Prendergast & Tornos, 2010). The three main indications for early surgery in IE are: HF, uncontrolled infection, and prevention of embolic events.…”

“…Emergency surgery (within 24 hours): NVE or PVE and severe congestive HF or cardiogenic shock caused by: acute valvular regurgitation, severe prosthetic dysfunction (dehiscence or obstruction), fistula into a cardiac chamber or the pericardial space -Urgent surgery (within days): NVE with persistent congestive HF, signs of poor hemodynamic tolerance, or abscess; PVE with persistent congestive heart failure, signs of poor hemodynamic tolerance, or abscess; PVE caused by staphylococci or Gramnegative organisms, large vegetation (> 10 mm) with an embolic event, large vegetation (> 10 mm) with other predictors of a complicated course, very large vegetation (> 15 mm), especially if conservative surgery is available, large abscess or periannular involvement with uncontrolled infection; -Early elective surgery (during the in-hospital stay): Severe aortic regurgitation with congestive HF and good response to medical therapy, PVE with valvular dehiscence or congestive heart failure and good response to medical therapy, presence of abscess or periannular extension, persistent infection when extracardiac focus has been excluded, fungal or other infections resistant to medical cure (Prendergast & Tornos, 2010).…”