Local administration of the powder minocycline during surgical intervention for active infective endocarditis
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ORIGINAL ARTICLE
Local administration of the powder minocycline during surgical intervention for active infective endocarditis Hiroshi Furukawa1 · Naoki Yamane1 · Takeshi Honda1 · Takahiko Yamasawa1 · Yuji Kanaoka1 · Kazuo Tanemoto1 Received: 18 September 2019 / Accepted: 12 January 2020 © The Japanese Association for Thoracic Surgery 2020
Abstract Objectives We retrospectively assessed the initial clinical impact of the locally administered bacteriostatic antibiotic, powder minocycline, during surgery for active infective endocarditis (AIE). Methods Among 38 surgical AIE patients, 36 patients who underwent surgical intervention for AIE using local administration of powder minocycline between January 2008 and August 2017 in our institute were enrolled. During surgery, the local administration and dispersion of powder minocycline at not only the valvular annulus and perivalvular cavity, but also the prosthetic cuff and ring were performed following the complete resection and aggressive debridement of infectious tissues. Early clinical outcomes, including survival, postoperative co-morbidities, and freedom from re-intervention or significant paravalvular leakage (PVL), were assessed. Results Early mortality within 30 days was 5.6% and hospital death was 13.9%. There was no reoperation within 30 days and only one patient (3.8%) developed recurrent infection, which improved with additional antibiotic treatments. More than moderate PVL within 30 days was detected in one patient only (3.8%). Over a median follow-up period of 38.3 ± 35.5 months, a Kaplan–Meier analysis revealed that 1- and 5-year survival rates were 75.7 and 66.8%, respectively, and freedom from reoperation was 100% at 5 years. Freedom from significant PVL at 5 years was 91.0%. Conclusions The local administration of powder minocycline may be a simple and effective manipulation during surgical intervention for AIE without extensive reconstruction; however, the surgical management of AIE remains challenging. Keywords Active infective endocarditis · Bacteriostatic antibiotic · Minocycline · Perivalvular abscess · Paravalvular leakage
Introduction In the last decade, the clinical outcomes of active infective endocarditis (AIE) have been improved by the early introduction of surgical repair [1] and precise clinical strategies, including prosthesis selection, strict and intensive perioperative management, and systemic antibiotic treatments. However, the surgical management of AIE remains challenging due to preoperative co-morbidities, such as cerebrovascular hemorrhage and postoperative local recurrence, and valverelated adverse outcomes, including paravalvular leakage (PVL), leading to re-intervention [2]. In complex cases with * Hiroshi Furukawa [email protected]‑m.ac.jp 1
Department of Cardiovascular Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama 701‑0192, Japan
aortic root or annular abscesses, surgical outcomes depend on surgical manipulations with extensive reconstruction and postoperative infection control, and, t
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