Surgical management of infective endocarditis: an analysis of early and late outcomes

Pang, Philip Y.K.; Sin, Yoong Kong; Lim, Chong Hee; Tan, Teing Ee; Lim, See Lim; Chao, Victor; Chua, Yeow Leng

doi:10.1093/ejcts/ezu281

Cited by 59 publications

(56 citation statements)

References 25 publications

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“…In our record, there was no data of genetic conditions like microdeletion 22q11, which are believed to be often associated with CHD and affect the immune system, making the patient vulnerable to various infections [14]. The outcome of our IE cohort was comparable to the literature [15].…”

Section: Discussionsupporting

confidence: 54%

Pulmonary valve and right ventricular outflow tract surgery in adults: 23-year experience

Szczechowicz¹,

Mkalaluh²,

Farag³

et al. 2018

Kardiol Pol

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A b s t r a c tBackground: Surgery of the pulmonary valve, right ventricular outflow tract, and pulmonary artery falls under the domain of paediatric cardiac surgery. However, 97 adult patients underwent such operations in our institution from 1993 to 2016. Aim:This study aims to analyse preoperative risk factors, intraoperative data, postoperative outcomes, and long-term survival to identify the potential predictors of mortality and high-risk patients. Methods:We divided our patient cohort into three groups in accordance with surgical indications: 17 patients with pulmonary valve endocarditis (group A), 70 patients with congenital defects involving the pulmonary valve (group B), and 10 patients who underwent pulmonary valve surgery for other indications, such as tumour or other acquired valvular disease (group C). Results:Gender distribution was comparable in all the three groups, with about 40% of the total number of patients being female. The mean age was 35.9 ± 15.7 years. Sixty (61.9%) patients had a history of cardiac surgery. Various concomitant cardiac surgical procedures were necessary in 49 (50.5%) cases. There were two (11.8%) in-hospital deaths in group A, two (2.9%) in group B, and none in group C. Within the mean follow-up time of 6.6 ±7.2 years, three (17.7%) patients in group A, two (2.9%) in group B, and four (40%) in group C died. Conclusions:Adult patients with pulmonary valve disease are often previously heart-operated and often need concomitant procedures. The operative risk in patients with pulmonary valve endocarditis is high. Surgery of congenital defects of the pulmonary valve is safe and can be performed with excellent outcomes.

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Section: Discussionsupporting

confidence: 54%

Pulmonary valve and right ventricular outflow tract surgery in adults: 23-year experience

Szczechowicz¹,

Mkalaluh²,

Farag³

et al. 2018

Kardiol Pol

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“…However, morbidity and mortality following cardiac surgery in patients with IE remain significant. AKI is one of the most common morbidities, with a rate of 20–60% [6, 22]. Moreover, AKI clearly increases long-term postoperative mortality and cardiac event rates in patients with IE [6, 23], but definitive strategies to prevent AKI in this patient population have not been established.…”

Section: Discussionmentioning

confidence: 99%

Effect of perioperative sodium bicarbonate administration on renal function following cardiac surgery for infective endocarditis: a randomized, placebo-controlled trial

et al. 2017

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BackgroundPatients with infective endocarditis (IE) have an elevated risk of renal dysfunction because of extensive systemic inflammation and use of nephrotoxic antibiotics. In this randomized, placebo-controlled trial, we investigated whether perioperative sodium bicarbonate administration could attenuate postoperative renal dysfunction in patients with IE undergoing cardiac surgery.MethodsSeventy patients randomly received sodium chloride (n = 35) or sodium bicarbonate (n = 35). Sodium bicarbonate was administered as a 0.5 mmol/kg loading dose for 1 h commencing with anesthetic induction, followed by a 0.15 mmol/kg/h infusion for 23 h. The primary outcome was peak serum creatinine (SCr) level during the first 48 h postoperatively. The incidence of acute kidney injury, SCr level, estimated glomerular filtration rate, and major morbidity endpoints were assessed postoperatively.ResultsThe peak SCr during the first 48 h postoperatively (bicarbonate vs. control: 1.01 (0.74, 1.37) mg/dl vs. 0.88 (0.76, 1.27) mg/dl, P = 0.474) and the incidence of acute kidney injury (bicarbonate vs. control: 29% vs. 23%, P = 0.584) were similar in both groups. The postoperative increase in SCr above baseline was greater in the bicarbonate group than in the control group on postoperative day 2 (0.21 (0.07, 0.33) mg/dl vs. 0.06 (0.00, 0.23) mg/dl, P = 0.028) and postoperative day 5 (0.23 (0.08, 0.36) mg/dl vs. 0.06 (0.00, 0.23) mg/dl, P = 0.017).ConclusionsPerioperative sodium bicarbonate administration had no favorable impact on postoperative renal function and outcomes in patients with IE undergoing cardiac surgery. Instead, it was associated with possibly harmful renal effects, illustrated by a greater increase in SCr postoperatively, compared to control.Trial registrationClinicalTrials.gov, NCT01920126. Registered on 31 July 2013.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1591-z) contains supplementary material, which is available to authorized users.

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“…In the present study, we evaluated clinical outcomes of patients who were operated for infective mitral endocarditis within 7 days or less of prior directed antimicrobial treatment (ES group) or later (DS group). Survival was reasonable in both the ES and DS groups in comparison to earlier reports, especially in light of the high number of multiple valve endocarditis and endocarditis involving the fibrous skeleton of the heart in the present series. In univariate analysis, there was no difference in operative mortality, valve repair rate, overall survival, recurrent MR, or reinfection rate between the groups.…”

Section: Discussionmentioning

confidence: 99%

Outcome of early vs delayed surgery for infective mitral endocarditis

2019

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Background and aim of the study Timing of surgery for infective endocarditis is controversial. The objective of this study was to report the outcomes of early vs delayed surgery (DS) of mitral endocarditis. Methods We retrospectively reviewed all patients treated surgically for mitral endocarditis between 2005 and 2016 in a single center. We analyzed midterm outcomes of early surgery (ES; surgery within 7 days or less of prior directed antibiotic treatment) in comparison to DS (surgery after more than 7 days of prior directed antibiotic treatment). Results Survival of all patients was 87% at one and 72% at 5 years. Mean follow‐up time was 4.0 ± 3.1 years. Thirty‐three (36.3%) patients were in the ES and 58 (63.7%) were in the DS group. Patients with ES were younger (47.4 vs 55.3 years), were in New York Heart Association class III or IV more frequently (97.0 vs 65.5%), and had higher EuroScore2 (15.6 vs 8.6%). The ES group had lower freedom from valve reoperation (98.2 vs 87.2%; P = .035) and the composite endpoint of >2 + regurgitation or reoperation at 5 years (98.2 vs 72.7%; P = .004). Conclusions ES was associated with a higher rate of reoperations and the composite endpoint of recurrent MR or reoperation.

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Surgical management of infective endocarditis: an analysis of early and late outcomes

Cited by 59 publications

References 25 publications

Pulmonary valve and right ventricular outflow tract surgery in adults: 23-year experience

Pulmonary valve and right ventricular outflow tract surgery in adults: 23-year experience

Effect of perioperative sodium bicarbonate administration on renal function following cardiac surgery for infective endocarditis: a randomized, placebo-controlled trial

Outcome of early vs delayed surgery for infective mitral endocarditis

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