Surgical treatment of active infective endocarditis: A continued challenge

David, Tirone E.; Gavra, Gheorghe; Feindel, Christopher M.; Regesta, Tommaso; Armstrong, Susan; Maganti, Manjula

doi:10.1016/j.jtcvs.2006.08.060

Cited by 240 publications

(226 citation statements)

References 21 publications

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“…Trzeba szczególnie starannie obserwować pacjenta, uwzględ-niając śmiertelność wewnątrzszpitalną chorych operowanych z powodu ostrego IZW w trybie pilnym lub nagłym, która w większości ocenianych serii przypadków wynosi 10-20% [1], a także zwiększone ryzyko powikłań pooperacyjnych. Do najczęściej występujących powikłań należą: ciężkie zaburzenia krzepnięcia, wymagające podawania czynników krzepnięcia, ponowne otwarcie klatki piersiowej ze względu na krwawienie lub tamponadę, ostra niewydolność nerek wymagająca hemodializ, udar mózgu, zespół niskiego rzutu, zapalenie płuc i blok przedsionkowo-komorowy w następ-stwie radykalnej resekcji ropnia opuszki aorty, co wiąże się z koniecznością pooperacyjnego leczenia elektrostymulacją stałą [325]. Blok lewej odnogi pęczka Hisa w elektrokardiogramie wykonanym przed operacją stanowi czynnik predykcyjny konieczności stałej stymulacji po zabiegu operacyjnym [23].…”

Section: Powikłania Pooperacyjneunclassified

2015 ESC Guidelines for the management of infective endocarditis

Habib¹,

Lancellotti

Antunes³

et al. 2015

Kardiol Pol

148

212

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Section: Powikłania Pooperacyjneunclassified

2015 ESC Guidelines for the management of infective endocarditis

Habib¹,

Lancellotti

Antunes³

et al. 2015

Kardiol Pol

148

212

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“…11 Each anatomical component of the aortic root has unique features, and all elements work in perfect harmony to minimize stress on the cusps, thus being highly efficient in a variety of hemodynamic conditions. 12 The aortic valve cusps are exposed to a unique hemodynamic environment, characterized by area-specific shear stress, bending forces and strains in circumferential and radial directions that vary in intensity and direction during each cardiac cycle. 9 To respond to these challenges, cusps have a trilayered (fibrosa, spongiosa, ventricularis) and anisotropic structure (stiffer in the circumferential axis vs. radial axis), which is essential for mechanical durability and stress distribution.…”

Section: Introductionmentioning

confidence: 99%

Functional Heart Valve Scaffolds Obtained by Complete Decellularization of Porcine Aortic Roots in a Novel Differential Pressure Gradient Perfusion System

Sierad

Shaw

Bina

et al. 2015

Tissue Engineering Part C: Methods

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There is a great need for living valve replacements for patients of all ages. Such constructs could be built by tissue engineering, with perspective of the unique structure and biology of the aortic root. The aortic valve root is composed of several different tissues, and careful structural and functional consideration has to be given to each segment and component. Previous work has shown that immersion techniques are inadequate for wholeroot decellularization, with the aortic wall segment being particularly resistant to decellularization. The aim of this study was to develop a differential pressure gradient perfusion system capable of being rigorous enough to decellularize the aortic root wall while gentle enough to preserve the integrity of the cusps. Fresh porcine aortic roots have been subjected to various regimens of perfusion decellularization using detergents and enzymes and results compared to immersion decellularized roots. Success criteria for evaluation of each root segment (cusp, muscle, sinus, wall) for decellularization completeness, tissue integrity, and valve functionality were defined using complementary methods of cell analysis (histology with nuclear and matrix stains and DNA analysis), biomechanics (biaxial and bending tests), and physiologic heart valve bioreactor testing (with advanced image analysis of open-close cycles and geometric orifice area measurement). Fully acellular porcine roots treated with the optimized method exhibited preserved macroscopic structures and microscopic matrix components, which translated into conserved anisotropic mechanical properties, including bending and excellent valve functionality when tested in aortic flow and pressure conditions. This study highlighted the importance of (1) adapting decellularization methods to specific target tissues, (2) combining several methods of cell analysis compared to relying solely on histology, (3) developing relevant valve-specific mechanical tests, and (4) in vitro testing of valve functionality.

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“…The calculated Euroscore was also significantly lower among surgical patients, and it was a strong marker of all-cause mortality during follow-up (hazard ratio, 1.30; 95% CI, 1.23 to 1.37; PϽ0.001). Operative characteristics and outcomes for surgical patients were comparable to other contemporary surgical series 18 (Table 2). Patients underwent surgery at a median time of 18 days after admission to hospital (interquartile range, 10 to 44 days), and the timing of surgery in relation to day of admission is shown in Figure 1.…”

Section: Patient Characteristicsmentioning

confidence: 59%

Survivor Treatment Selection Bias and Outcomes Research

Bannon

Bayfield

et al. 2009

Circ: Cardiovascular Quality and Outcomes

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Background-Recent studies in infective endocarditis have suggested an association between surgery and reduced mortality. However, these studies did not account for survivor treatment selection bias, which is an underrecognized source of error in observational studies. Therefore, we sought to evaluate the effects of survivor bias on surgical outcomes in infective endocarditis. Methods and Results-We studied 223 patients admitted with left-sided infective endocarditis between 1996 and 2006 and compared all-cause mortality between surgically treated and medically treated patients using Cox regression analysis. Propensity scores were used to account for selection bias, and time-dependent analyses were performed to account for survivor bias. Compared with medical patients (nϭ161), surgical patients (nϭ62) had lower mortality during a median follow-up of 5.2 years (32% versus 51%; Pϭ0.02) with an unadjusted hazard ratio of 0.54 (95% CI, 0.33 to 0.88, Pϭ0.01). After adjustment for baseline differences in propensity for surgery and risk of mortality, there remained a significant benefit for surgery (hazard ratio, 0.50; 95% CI, 0.28 to 0.88; Pϭ0.02). However, this was diminished after time-dependent analysis (hazard ratio, 0.77; 95% CI, 0.42 to 1.40; Pϭ0.39).Conditional Kaplan-Meier analyses confirmed the effect of survivor bias because the apparent benefit of surgery was primarily attributable to excess mortality in the medical group during early hospitalization when surgery was not frequently performed. Conclusions-Survivor

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Surgical treatment of active infective endocarditis: A continued challenge

Abstract: Surgery for endocarditis continues to be challenging and associated with high operative mortality and morbidity. Age, shock, prosthetic valve endocarditis, impaired ventricular function, and recurrent infections adversely affect long-term survival.

Cited by 240 publications

References 21 publications

2015 ESC Guidelines for the management of infective endocarditis

2015 ESC Guidelines for the management of infective endocarditis

Functional Heart Valve Scaffolds Obtained by Complete Decellularization of Porcine Aortic Roots in a Novel Differential Pressure Gradient Perfusion System

Survivor Treatment Selection Bias and Outcomes Research

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