Early and intermediate outcomes for surgical management of infective endocarditis
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(2019) 14:211
RESEARCH ARTICLE
Open Access
Early and intermediate outcomes for surgical management of infective endocarditis Lindsay Volk, Nina Verghis, Antonio Chiricolo, Hirohisa Ikegami, Leonard Y. Lee and Anthony Lemaire*
Abstract Objective: The treatment of active infective endocarditis (IE) presents a clinical dilemma with uncertain outcomes. This study sets out to determine the early and intermediate outcomes of patients treated surgically for active IE at an academic medical center. Methods: A retrospective chart review was conducted to identify patients who underwent surgical intervention for IE at our institution from July 1st, 2011 to June 30th, 2018. In-patient records were examined to determine etiology of disease, surgical intervention type, postoperative complications, length of stay (LOS), 30-day in-hospital mortality, and 1-year survival. Results: Twenty-five patients underwent surgical intervention for active IE. The average age of the patients was 47 ± 14 years old and most of the patients were male (N = 15). The majority of the patients had the mitral valve replaced (N = 10), with the remaining patients having tricuspid (N = 8) and aortic (N = 7) valve replacements. The etiology varied and included intravenous drug use (IVDU), and presence of transvenous catheters. The 30-day inhospital mortality was 4% with 1 patient death and the 1-year survival was 80%. The average LOS was 27 days ±15 and the longest LOS was 65 days. Conclusions: Surgical management of IE can be difficult and challenging however mortality can be minimized with acceptable morbidity. The most common complication was CVA. The average LOS is longer than traditional adult cardiac surgery procedures and the recurrence rate of valvular infection is not minimal especially if the underlying etiology is IVDU. Keywords: Endocarditis, Intravenous drug use, Valve replacement
Introduction Infective endocarditis (IE) is a rare disease, but its impact is significant [1]. It affects 3 to 10 per 100,000 per year in the population at large and the studies suggest that the incidence is rising [2]. Despite recent advances in treatment, IE remains a life-threatening disease with significant morbidity and mortality [3, 4]. The rise of antibiotic resistance against the main causative organisms has made medical management increasingly difficult [4]. As a complement to the medical management
* Correspondence: [email protected] Division of Cardiothoracic Surgery, Department of Surgery, RUTGERS-Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ 08903, USA
of IE, surgery remains a treatment option for some of the patients with IE. Surgical intervention is warranted in IE for a variety of indications including unsuccessful medical therapy, involvement of a prosthetic valve, recurrent embolization, or embolization with residual large vegetations [3]. Over the past 10 years, there is evidence to suggest the importance of surgery as a treatment option in this population [3]. The surgical treatment of active infe
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