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[Proceedings: Surgical treatment of infectious endocarditis]
Insights
Surgical intervention for infective endocarditis is crucial for prophylaxis and managing complications like cardiac failure. Early surgery for acute valvular insufficiency remains a debated topic, especially in active infections.
Area of Science:
- Cardiology
- Cardiac Surgery
- Infectious Diseases
Context:
- Infective endocarditis presents complex surgical challenges, particularly when associated with active infection and cardiac failure.
- Surgical intervention is employed prophylactically, for residual valvular defects post-healing, and in refractory cases.
- The timing of surgery for acute valvular insufficiency with mild cardiac failure is a subject of ongoing debate.
Purpose:
- To discuss the indications and challenges of surgical therapy for infective endocarditis.
- To present personal case experiences with surgical management of active infective endocarditis.
- To highlight the role of surgery in fungal endocarditis and complex cases requiring multiple interventions.
Summary:
- Surgical therapy for infective endocarditis encompasses prophylactic measures, elective correction of sequelae, and management of active infections with cardiac compromise.
- While surgery for life-threatening failure is standard, early intervention for mild failure due to acute valvular insufficiency is controversial.
- Valve replacement is less common but necessary for antibiotic-refractory valvular dysfunction. Fungal endocarditis necessitates prompt surgical intervention.
- Seven cases of active infection managed surgically are presented, with all patients surviving. One fungal endocarditis case required three valve replacements.
Impact:
- This study underscores the critical role of surgical intervention in managing infective endocarditis, even in active infection.
- It provides insights into the complex decision-making process regarding the timing of surgery, especially in cases of mild cardiac failure.
- The findings emphasize the effectiveness of surgical management, including complex cases and fungal infections, leading to improved patient outcomes.
Abstract:
Surgical therapy of infective endocarditis can be undertaken as a prophylactic measure to avoid infection, e.g. in patent ductus arteriosus. In the majority of cases operations are done electively for correction of residual valvular defects ensuing on healed endocarditis. The most challenging problem is cardiac failure in the presence of active infection. While the surgical indication for life-threatening failure is generally recognized, the necessity of early operation, i.e. for acute valvular insufficiency with only mild cardiac failure, is still controverted. Valve replacement to remove a valvular form refractory to antibiotic therapy is less frequently necessary. In fungal endocarditis surgical intervention is recommended as soon as the diagnosis is established. Seven personal cases operated on in the presence of active infection are presented. All survived, but in one patient with fungal endocarditis the infected valve had to be replaced three times before healing was achieved.