Abstract
Cardiac surgery is required in more than 50% of patients with active infective endocarditis. Patients should be referred to an expert center for rapid evaluation. Surgical indication and timing have to be defined by an endocarditis team. Early surgery is beneficial not only in the absence of cerebral complications but also in patients with cerebral infarction without coma. Management of patients with intracranial hemorrhage remains very complex, but surgery may be performed within the first month after hemorrhagic stroke in selected patients if there is a strong indication for early surgery. The aim of surgery is (a) to eradicate the infection removing all the infected structures and materials, (b) to allow a bacteriological diagnosis, and (c) to perform an anatomical reconstruction of affected structures.
The use of foreign materials should be kept to a minimum, reducing the incidence of recurrent infection. Valve repair is preferable to valve replacement, and when a durable valve repair is not feasible, a tailored approach for each patient and the clinical situation should be recommended for the choice of the valve substitute.
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Oliver L, Lepeule R, Moussafeur A, Fiore A, Lim P. Ternacle Early surgery in infective endocarditis: why should we wait? J Arch Cardiovasc Dis. 2016;109(12):651–4.
Vongpatanasin W, Hillis LD, Lange RA. Prosthetic heart valves. N Engl J Med. 1996;335:407–16.
Habib G, Thuny F, Avierinos JF. Prosthetic valve endocarditis: current approach and therapeutic options. Prog Cardiovasc Dis. 2008;50:274–81.
Habib G, Lancellotti P, Antunes MJ, et al. ESC Guidelines for the management of infective endocarditis: the Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J. 2015;36:3075–128.
Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. J Am Coll Cardiol. 2014;63:e57–185.
Durak DT, Lukes AS, Bright DK. New criteria for diagnosis of infective endocarditis: utilization of specific echocardiography finding. Duke Endocarditis Service. Am J Med. 1994;96:200–9.
The 2015 ESC Guidelines for the management of infective endocarditis. Eur Heart J. 2015;36:3075–23. https://doi.org/10.1093/eurartj/ehv319.
Iung B, Doco-Lecompte T, Chocron S, et al. Cardiac surgery during the acute phase of infective endocarditis: discrepancies between European Society of Cardiology guidelines and practices. Eur Heart J. 2016;37:840–8.
Stout KK, Verrier ED. Valvular heart disease: changing concepts in disease management. Circulation. 2009;119:3232–41.
Sanchez-Enrique C, Vilacosta I, Moreno HG, Delgado-Bolton R, Perez-Alonso P, Martinez A, Vivas D, Ferrera C, Olmos C. Infected marantic endocarditis with leukemoid reaction. Circ J. 2014;78:2325–7.
Yong MS, Saxena P, Killu AM, Coffey S, Burkart HM, Wan S-H, Malouf JF. The preoperative evaluation of infective endocarditis via 3-dimensional transesophageal echocardiography. Tex Heart Inst J. 2015;42:372–6.
Vrettou AR, Zacharoulis A, Lerakis S, Kremastinos DT. Revealing infective endocarditis complications by echocardiography: the value of real-time 3D transesophageal echocardiography. Hell J Cardiol. 2013;54(2):147–9.
Habib G, Badano L, Tribouilloy C, Vilacosta I, Zamorano JL, Galderisi M, Voigt JU, Sicari R, Cosyns B, Fox K, Aakhus S. Recommendations for the practice of echocardiography in infective endocarditis. Eur J Echocardiogr. 2010;11:202–19.
Feuchtner GM, Stolzmann P, Dichtl W, Schertler T, Bonatti J, Scheffel H, Mueller S, Plass A, Mueller L, Bartel T, Wolf F, Alkadhi H. Multislice computed tomography in infective endocarditis: comparison with transesophageal echocardiography and intraoperative findings. J Am Coll Cardiol. 2009;53:436–44.
Frontera JA, Gradon JD. Right-side endocarditis in injection drug users: review of proposed mechanisms of pathogenesis. Clin Infect Dis. 2000;30:374–9.
Wilson LE, Thomas DL, Astemborski J, Freedman TL, Vlahov D. Prospective study of infective endocarditis among injection drug users. J Infect Dis. 2002;185:1761–6.
Kang DH. Timing of surgery in infective endocarditis. Heart. 2015;101(22):1786–91.
Delahaye F. Is early surgery beneficial in infective endocarditis? A systematic review. Arch Cardiovasc Dis. 2011;104:35–44.
Thuny F, Beurtheret S, Mancini J, et al. The timing of surgery influences mortality and morbidity in adults with severe complicated infective endocarditis: a propensity analysis. Eur Heart J. 2011;32:2027–33.
Lalani T, Cabell CH, Benjamin DK, et al. Analysis of the impact of early surgery on in-hospital mortality of native valve endocarditis: use of propensity score and instrumental variable methods to adjust for treatment-selection bias. Circulation. 2010;121:1005–13.
Anantha Narayanan M, Mahfood Haddad T, Kalil AC, et al. Early versus late surgical intervention or medical management for infective endocarditis: a systematic review and meta-analysis. Heart. 2016;102:950–7.
Grande AM, Amoroso F, Crimi G, Ferrario M, Mazzola A. Mitral-aortic intervalvular fibrosa pseudoaneurysm causing systolic compression of left main trunk. Ann Thorac Surg. 2017;103:e461.
Chesler E, Korns ME, Porter GE, Reyes CN, Edwards JE. False aneurysm of the left ventricle secondary to bacterial endocarditis with perforation of the mitral-aortic intervalvular fibrosa. Circulation. 1968;37:518–23.
Moorthy N, Kumar S, Tewari S, et al. Mitral-aortic intervalvular fibrosa aneurysm with rupture into left atrium: an uncommon cause of acute dyspnea. Heart Views. 2012;13:13–5.
Ihdayhid AR, Asrar UI, Hag M, Dembo L, Yong G. Simultaneous coronary and pulmonary angiography to diagnose critical left main coronary artery stenosis secondary to dilated pulmonary artery. JACC Cardiovascular Interv. 2016;9(11):1193–4.
Dahya VJ, Chalasani P. Sinus of Valsalva aneurysm causing extrinsic compression of the left main coronary artery. JACC Cardiovascular Interv. 2015;8(6):e99–100.
Kim HW, Chung CH. Mitral-aortic intervalvular fibrosa pseudoaneurysm resulting in the displacement of the left main coronary artery after aortic valve replacement. J Thorac Cardiovasc Surg. 2010;139:e18–20.
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Fiore, A., Mazzola, A., Grande, A.M. (2019). Emergency Management of Infective Endocarditis. In: Aseni, P., De Carlis, L., Mazzola, A., Grande, A.M. (eds) Operative Techniques and Recent Advances in Acute Care and Emergency Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-95114-0_39
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DOI: https://doi.org/10.1007/978-3-319-95114-0_39
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