Indications for cardiac surgery in patients with active infective endocarditis

Alsip, Steven G.; Blackstone, Eugene H.; Kirklin, John W.; Cobbs, Charles

doi:10.1016/0002-9343(85)90376-6

Cited by 95 publications

(26 citation statements)

References 50 publications

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“…282 In addition, a second, albeit infrequent, peak of late embolic events has been observed to occur 15 to 30 weeks after the diagnosis of IE and has been associated with nonhealing vegetations (failure of a vegetation to stabilize or diminish in size) as defined by echocardiography. 63 The traditional indication for valvular surgery for IE to avoid embolization has been ≥2 major embolic events.…”

Section: Risk Of Embolizationmentioning

confidence: 99%

Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications

Baddour¹,

Wilson²,

Bayer³

et al. 2015

Circulation

2,479

1,421

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Background— Infective endocarditis is a potentially lethal disease that has undergone major changes in both host and pathogen. The epidemiology of infective endocarditis has become more complex with today’s myriad healthcare-associated factors that predispose to infection. Moreover, changes in pathogen prevalence, in particular a more common staphylococcal origin, have affected outcomes, which have not improved despite medical and surgical advances. Methods and Results— This statement updates the 2005 iteration, both of which were developed by the American Heart Association under the auspices of the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease of the Young. It includes an evidence-based system for diagnostic and treatment recommendations used by the American College of Cardiology and the American Heart Association for treatment recommendations. Conclusions— Infective endocarditis is a complex disease, and patients with this disease generally require management by a team of physicians and allied health providers with a variety of areas of expertise. The recommendations provided in this document are intended to assist in the management of this uncommon but potentially deadly infection. The clinical variability and complexity in infective endocarditis, however, dictate that these recommendations be used to support and not supplant decisions in individual patient management.

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Section: Risk Of Embolizationmentioning

confidence: 99%

Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications

Baddour¹,

Wilson²,

Bayer³

et al. 2015

Circulation

2,479

1,421

View full text Add to dashboard Cite

show abstract

“…58 The traditional indications for valvular surgery for IE to avoid embolization have been Ն2 major embolic events. 229 These criteria are arbitrary and exclude cutaneous embolization, which is common, or embolism occurring before the institution of therapy. 229 Because of the observed decreases in embolic risk during the first 2 weeks of antibiotic therapy, the benefit of surgery in avoiding catastrophic embolic events is greatest early in the treatment course of IE.…”

Section: Risk Of Embolizationmentioning

confidence: 99%

“…229 These criteria are arbitrary and exclude cutaneous embolization, which is common, or embolism occurring before the institution of therapy. 229 Because of the observed decreases in embolic risk during the first 2 weeks of antibiotic therapy, the benefit of surgery in avoiding catastrophic embolic events is greatest early in the treatment course of IE. Early surgical intervention may preclude a primary or recurrent major embolic event but exposes the patient to both the immediate and lifelong risks of valve replacement.…”

Section: Risk Of Embolizationmentioning

confidence: 99%

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Infective Endocarditis

Baddour¹,

Wilson²,

Bayer³

et al. 2005

Circulation

1,275

436

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Background-Despite advances in medical, surgical, and critical care interventions, infective endocarditis remains a disease that is associated with considerable morbidity and mortality. The continuing evolution of antimicrobial resistance among common pathogens that cause infective endocarditis creates additional therapeutic issues for physicians to manage in this potentially life-threatening illness. Methods and Results-This work represents the third iteration of an infective endocarditis "treatment" document developed by the American Heart Association under the auspices of the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease of the Young. It updates recommendations for diagnosis, treatment, and management of complications of infective endocarditis. A multidisciplinary committee of experts drafted this document to assist physicians in the evolving care of patients with infective endocarditis in the new millennium. This extensive document is accompanied by an executive summary that covers the key points of the diagnosis, antimicrobial therapy, and management of infective endocarditis. For the first time, an evidence-based scoring system that is used by the American College of Cardiology and the American Heart Association was applied to treatment recommendations. Tables also have been included that provide input on the use of echocardiography during diagnosis and treatment of infective endocarditis, evaluation and treatment of culture-negative endocarditis, and short-term and long-term management of patients during and after completion of antimicrobial treatment. To assist physicians who care for children, pediatric dosing was added to each treatment regimen. Conclusions-The recommendations outlined in this update should assist physicians in all aspects of patient care in the diagnosis, medical and surgical treatment, and follow-up of infective endocarditis, as well as management of associated complications. Clinical variability and complexity in infective endocarditis, however, dictate that these guidelines be used to support and not supplant physician-directed decisions in individual patient management. (Circulation. 2005; 111:e394-e433.)

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“…97 These criteria are arbitrary and exclude cutaneous embolization, which is common, or embolism occurring before the institution of therapy. 98 Because of the known decrease in embolic risk over the first 2 weeks of antibiotic therapy, the benefit of surgery in avoiding catastrophic embolic events is greatest early in the course of the IE. Early surgical intervention may preclude a primary or recurrent major embolic event but exposes the patient to both the immediate and the life-long risks of valve replacement.…”

Section: Risk Of Embolizationmentioning

confidence: 99%