Commentary: When is repeated cardiac valve surgery justified during drug-associated infective endocarditis?

Mennander, Ari

doi:10.1016/j.jtcvs.2019.06.081

Cited by 4 publications

(2 citation statements)

References 4 publications

(9 reference statements)

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“…Hayden and Moore's 2019 qualitative study showed that implicit and explicit bias were pervasive among surgeons interviewed, and futility and rationing of care were the lead reasons behind their surgical decision making. 31 While several outcomes studies of IDU-IE discuss treatment approaches, 6,7,32,33 and surgeons and ethicists have contributed to the discussion in the form of commentaries, 17,18,34,35 this is the first study that quantitatively describes cardiac surgeons' treatment approaches between patients with IDU-IE vs patients with non-IDU-IE.…”

Section: Discussionmentioning

confidence: 99%

Cardiac Surgeons’ Treatment Approaches for Infective Endocarditis Based on Patients’ Substance Use History

Tiako

Mszar

Brooks

et al. 2021

Seminars in Thoracic and Cardiovascular Surgery

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U.S. cardiac surgeons encounter complex decision-making when treating patients with injection drug use-associated infective endocarditis (IDU-IE). We evaluated surgeons' treatment approaches for IDU-IE compared to non-IDU-IE. This is an anonymous survey of U.S. cardiac surgeons who answered hypothetical infective endocarditis (IE) clinical scenarios that varied based on patient substance use history, addiction treatment, and history of IE. Treatment approaches were classified as operative vs nonoperative.Responses were descriptively analyzed. The survey response rate was 8.7% (n = 208). Survey respondents were mostly male (85.6%) and non-Hispanic white (67.8%), but were from all regions of the United States. Surgeons reported they would operate at similar proportions for patients with native valve non-IDU-IE (63%) and IDU-IE engaged in methadone treatment (64.5%). Most surgeons reported they would operate on patients with recurrent non-IDU-IE (93.1%) compared to only 26.4% for patients with recurrent IDU-IE (P < 0.001). Most surgeons reported they would place no limits on the number of operations for patients with recurrent non-IDU-IE (73.1%), whereas 83.5% of surgeons would limit the number of surgeries for patients with recurrent IDU-IE (P < 0.001). Most respondents reported having declined to operate on patients with IDU-IE (63.5%). Cardiac surgeons are less likely to report favoring operative management for primary and recurrent infection in patients with IDU-IE, though patient engagement in methadone treatment increased the likelihood of them taking an operative approach. There is opportunity to standardize the care, including addiction treatment, of patients with IDU-IE to optimize positive short and long-term outcomes.

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Section: Discussionmentioning

confidence: 99%

Cardiac Surgeons’ Treatment Approaches for Infective Endocarditis Based on Patients’ Substance Use History

Tiako

Mszar

Brooks

et al. 2021

Seminars in Thoracic and Cardiovascular Surgery

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“…Finally, the effects of the operation and the quality of life of patients are affected [ 4 ]. Continuous nursing is a kind of continuous nursing for patients after discharge under the guidance of medical staff to reduce the occurrence of postoperative adverse symptoms and improve the quality of life after operation [ 5 ]. Some studies showed that quality care for patients after heart valve replacement can significantly reduce the incidence of postoperative complications.…”

Section: Introductionmentioning

confidence: 99%

Effect of Different Nursing Interventions on Discharged Patients with Cardiac Valve Replacement Evaluated by Deep Learning Algorithm‐Based MRI Information

Zhang

Zhou

2022

Contrast Media & Molecular Imaging

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This study was aimed to explore the application of cardiac magnetic resonance imaging (MRI) image segmentation model based on U-Net in the diagnosis of a valvular heart disease. The effect of continuous nursing on the survival of discharged patients with cardiac valve replacement was analyzed in this study. In this study, the filling completion operation, cross entropy loss function, and guidance unit were introduced and optimized based on the U-Net network. The heart MRI image segmentation model ML-Net was established. We compared the Dice, Hausdorff distance (HD), and percentage of area difference (PAD) values between ML-Net and other algorithms. The MRI image features of 82 patients with valvular heart disease who underwent cardiac valve replacement were analyzed. According to different nursing methods, they were randomly divided into the control group (routine nursing) and the intervention group (continuous nursing), with 41 cases in each group. The Glasgow Outcome Scale (GOS) score and the Self-rating Anxiety Scale (SAS) were compared between the two groups to assess the degree of anxiety of patients and the survival status at 6 months, 1 year, 2 years, and 3 years after discharge. The results showed that the Dice coefficient, HD, and PAD of the ML-Net algorithm were (0.896 ± 0.071), (5.66 ± 0.45) mm, and (15.34 ± 1.22) %, respectively. The Dice, HD, and PAD values of the ML-Net algorithm were all statistically different from those of the convolutional neural networks (CNN), fully convolutional networks (FCN), SegNet, and U-Net algorithms P < 0.05 . Atrial, ventricular, and aortic abnormalities can be seen in MRI images of patients with valvular heart disease. The cardiac blood flow signal will also be abnormal. The GOS score of the intervention group was significantly higher than that of the control group P < 0.01 . The SAS score was lower than that of the control group P < 0.05 . The survival rates of patients with valvular heart disease at 6 months, 1 year, 2 years, and 3 years after discharge were significantly higher than those in the control group P < 0.05 . The abovementioned results showed that an effective segmentation model for cardiac MRI images was established in this study. Continuous nursing played an important role in the postoperative recovery of discharged patients after cardiac valve replacement. This study provided a reference value for the diagnosis and prognosis of valvular heart disease.

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Reply: Drug-associated infective endocarditis is a worldwide mutual challenge

Mennander

2020

The Journal of Thoracic and Cardiovascular Surgery

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2 described the daunting increases in the incidence and repeated surgery for drug-associated infective endocarditis. The necessity for postoperative follow-up of the disease was further discussed previously, 3 and Chilvers and Clark 1 emphasized that follow-up of the disease might be most efficient in Europe. 1 At present, some parts of Europe have a relatively low number of drug abusers 4 ; however, drug-associated infective endocarditis is, sadly, expected to increase worldwide with time. 5,6 Information on intoxicants is easily accessible. Remote places are adopting mainstream trends. The media, the internet, popular culture, underground music, and free travel, all appeal to the young and sensitive. The spread of infection, fashion, and behavior culminate in the complex setup of drug-associated infective endocarditis.Once attained, drug-associated infective endocarditis will develop to its full horror despite any geographic area of the individual patient. 7 The outcome after surgery for drug-associated infective endocarditis has been dismal compared with many other etiologies of endocarditis. 4,7 Mori and colleagues 2 showed that the incidence of drugassociated infective endocarditis is increasing rapidly. The message should be taken seriously, and we should be prepared for a rapid increase in the incidence of drugassociated infective endocarditis, regardless of the current local baseline frequency of the disease.In addition to vigilant follow-up, we should thus also aim at preventive measures by educating children, enhancing social equality, and supporting the community as a whole. Social security ensures that the sick receive proper treatment; the infective hot spots must be hampered for individuals' and society's sake. Sharing transparent information within and between countries will enhance our learning to control different infections. The key is to balance freedom

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Commentary: When is repeated cardiac valve surgery justified during drug-associated infective endocarditis?

Cited by 4 publications

References 4 publications

Cardiac Surgeons’ Treatment Approaches for Infective Endocarditis Based on Patients’ Substance Use History

Cardiac Surgeons’ Treatment Approaches for Infective Endocarditis Based on Patients’ Substance Use History

Effect of Different Nursing Interventions on Discharged Patients with Cardiac Valve Replacement Evaluated by Deep Learning Algorithm‐Based MRI Information

Reply: Drug-associated infective endocarditis is a worldwide mutual challenge

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