Download Immediate result of Surgical outcome of infective

surgical outcome of native
valve infective endocarditis
in srinagarind hospital
2004-2005
Worawit Intanoo MD.
Sompop pratanee MD.
Cardiovascular- thoracic unit, Department of
surgery, Khonkaen university
Background
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


Native valve infective endocarditis (NVE) is
associated with a myriad of complications.
Khonkaen prevalence was 4 patients per 1,000
hospital admissions.
In-hospital mortality was 25 per cent.
During the first month after admission, 45 per
cent of the patients underwent surgery.
Pachirat O et al . Infective endocarditis: prevalence, characteristics
and mortality in Khon Kaen, 1990-1999. J Med Assoc Thai. 2002
Jan;85(1):1-10.
Background


During the last three decades, valve replacement
and even valve repair have become
commonplace in the management of selected
complications of NVE.
Valve surgery was associated with reduced
mortality.
Vikram HR et al. Impact of valve surgery on 6 month mortality in
adult with complicated, left sided native valve endocarditis. JAMA 2003
Dec 24;290(24):3207-14
Indication for surgery
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valve dysfunction leading to heart failure (1B)
infection with difficult to treat pathogens (1C)
valve destruction resulting in severe
regurgitation with hemodynamic evidence of
elevated left ventricular end-diastolic or left atrial
pressures (1C)
the 2006 American College of Cardiology/American Heart Association
(ACC/AHA) guidelines
Indication for surgery
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persistent infection, including paravalvular
abscess (1C)
embolic events while on an appropriate
antibiotic regimen OR associated with a large
vegetation (2C)
mobile, large (>10 mm) left sided vegetations
with or without emboli (IIC)
the 2006 American College of Cardiology/American Heart Association
(ACC/AHA) guidelines
Methodology
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Retrospective Descriptive study
January 2004 – December 2005
23 NVE patients
Demographic data
Age : year (mean)
39.4
Sex (male: female)
2:1
Comorbidity, risk factor
DM : n%
4 (17.4)
CKD : n%
1(4.3)
HIV : n%
1(4.3)
Liver cirrhosis ; n%
1(4.3)
Marfan’s syndrome : n%
1(4.3)
Demographic data
Dyspnea status
NYHA I : n%
NYHA II : n%
5 (22)
NYHA III : n%
6 (26)
NYHA IV : n%
12 (52)
Diagnostic tool
Hemoculture positive : n%
5(21.7)
echocardiogram
Annular abscess : n%
Vegetation : n%
Interventricular abscess : n%
11(48)
15(65.3)
1(4.2)
organism
S. Viridan : n%
4(14.7)
S. epidermidis :n%
1(4.2)
operation
Interval between diagnosis and surgery
: hours (mean)
54.6
procedure
MVR : n%
AVR : n%
Aortic root replacement : n%
MV repair : n%
CPB time : min(mean)
Aortic cross clamp time : min(mean)
3(13)
18(78)
1(4.2)
1(4.2)
97
53.4
outcome
ICU stay : day (mean)
Hospital stay : day (mean)
Hospital mortality : n%
8.2
27.3
6(26)
complication
Heart failure : n%
Re-operation (bleeding) : n%
Complete heart block : n%
Acute renal failure : n%
15(65)
2(8.6)
2(8.6)
4(17.2)
Paravalvular leakage : n%
4(17.2)
summary
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NVE is not uncommon condition in srinagarind
hospital.
Hospital mortality rate is still high.
discussion
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Consideration for surgery in patients with native
valve endocarditis must involve a decision
analysis that balances the risks of medical
treatment with those of surgical intervention,
including
operative mortality and morbidity,
 recurrent embolization,
 co-morbidities,
 the long-term complications of valvular prostheses
and anticoagulation.

discussion
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Surgery should not be delayed to complete
antimicrobial therapy in patients with
progressive HF or evidence of other
complications.