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Related Experiment Videos

Valve replacement in patients with active infective endocarditis.

W R Wilson, G K Danielson, E R Giuliani

    Circulation
    |October 1, 1978
    PubMed
    Summary

    Cardiac valve replacement for infective endocarditis (IE) can be successful even with active infection. Patient hemodynamic status, not infection activity, should guide surgery timing for better outcomes.

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    Area of Science:

    • Cardiology
    • Infectious Diseases
    • Cardiac Surgery

    Background:

    • Infective endocarditis (IE) is a serious infection affecting heart valves.
    • Active IE poses challenges for cardiac valve replacement surgery.

    Purpose of the Study:

    • To evaluate the outcomes of cardiac valve replacement in patients with active infective endocarditis.
    • To determine optimal timing for valve replacement surgery in IE patients.

    Main Methods:

    • Retrospective analysis of 138 patients undergoing valve replacement for IE over 12.5 years.
    • Focus on 11 patients with active IE at the time of surgery.
    • Analysis of preoperative blood cultures, Gram stains, tissue cultures, and New York Heart Association (NYHA) functional class.

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    Main Results:

    • Eleven of 138 patients had active IE, all with NYHA Class IV disability.
    • Staphylococci were the most common pathogens.
    • Three patients died; two deaths were associated with sudden severe aortic regurgitation and heart failure.
    • Prosthetic valve endocarditis occurred in one patient.

    Conclusions:

    • Cardiac valve replacement can be successful in active IE, even with positive perioperative cultures.
    • Hemodynamic status is the primary determinant for surgical timing, superseding infection activity or duration of antimicrobial therapy.
    • Radical surgery may be required for abscesses complicating aortic valve replacement.