Infective Endocarditis: Therapeutic Options and Indications for Surgery

Abstract

Infective endocarditis is a serious, life-threatening condition with mortality of 30% at one year. Established treatment is a combination of anti-microbial therapy and close interface between multiple specialist teams of cardiologists, microbiologists and cardiac surgeons to ensure availability of early surgery to those patients who require it. There are evidence-based established indications for surgery and a shifting body of evidence advocating earlier surgical intervention. The development of complications is often the driving cause of referral for surgical intervention. Here we discuss the management of infective endocarditis, considering both antimicrobial therapy and indications for surgery to treat this debilitating disease.

Cross-sectional imaging of aortic infections

“…Infective endocarditis (IE) of the aortic valve is a serious, life-threatening condition, with a mortality rate of 30 % at 1 year [11]. It is caused by infection of the aortic valve, either native or prosthetic.…”

Infective Endocarditis: Diagnosis, Treatment and Prevention: Review

“…Cerrahi tedavi, acil (<24 saat), ivedi (<7 gün) veya elektif (tedaviden bir-iki hafta sonra) olarak yapılmaktadır. 6,31,32 Cerrahinin amacı, enfeksiyonu ortadan kaldırmak ve kardiyak yapıda düzeltici girişim (onarım veya replasman) yapmaktır. Mümkün olduğu kadar onarım öneril-mektedir.…”

“…Akut akciğer ödemi veya kardiyojenik şok geliştiğinde, acil cerrahi tedavi öneril-mektedir. 31,32 Kapak disfonksiyonu tolere ediliyorsa, antibiyotik tedavisi ve stabilizasyon için cerrahi biraz (beş-yedi gün) geciktirilmektedir. 2,6 İnfeksiyonun perivalvuler bölgeye yayılmasıyla apse, psödoanevrizma, fistül veya AV tam blok ge- lişebilir.…”

“…Yine, ısrarcı enfeksiyon (>7-10 gün), eradikasyonu zor veya pek çok ilaca direnç gösteren etkenlerin (S. aureus, S. lugdunensis, Pseudomonas ve mantar gibi) varlığında sıklıkla cerrahi gereklidir. 6,31,32 Hastaların %25-30'unda emboli gelişebilmek-tedir. En sık embolizasyon, santral sinir sistemine olmakta ve inmeye yol açmaktadır.…”

Infective endocarditis

“…For non-HACEK gram negative bacteria, treatment with early surgery and bacteriocidal treatment for over 6 weeks was recommended by the ESC guidelines. Surgery for IE is an important part of management in selected cases, and there is a shifting body of evidence advocating earlier surgical intervention (Malhotra, Rayner, Williams, & Prendergast, 2014). Currently, it is recommended that surgery is performed for complicated left-sided IE and those with congestive heart failure.…”