The role of surgical treatment in infective endocarditis: early and late results
| Autor: | R. C. MüLler-Haake, S. Effert, Bruno J. Messmer, C. Minale, Rainer Uebis, Heinz Lambertz, E. von der Lohe |
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| Rok vydání: | 1987 |
| Předmět: |
medicine.medical_specialty
Septic shock business.industry medicine.medical_treatment medicine.disease Surgery Sepsis Pneumonia medicine.anatomical_structure Valve replacement Infective endocarditis Heart failure Mitral valve medicine Cardiology and Cardiovascular Medicine Multiple organ dysfunction syndrome business |
| Zdroj: | European Heart Journal. 8:367-370 |
| ISSN: | 1522-9645 0195-668X |
| DOI: | 10.1093/eurheartj/8.suppl_j.367 |
| Popis: | Between 1978 and 1986, 57 consecutive patients aged 17–72 years (mean 53 ± 2) were operated on at our institute because of infective endocarditis. In 50% of the cases, blood cultures were negative although in a few cases bacteria could be seen on microscopic examination of the explanted valves. Primary indications for valve replacement were progressive heart failure (CHF) and/or uncontrollable sepsis (SEP). During a total of 57 primary procedures, 51 aortic and 18 mitral valves were replaced. Hospital mortality was 10.5% (6 patients). Causes of death were septic shock and/or congestive heart failure, as well as multi-organ failure. Survivors were followed up to a total of 51 patient-years with a mean of 1.4 patient-years. Four patients were reoperated because of a sterile paravalvular leak and three because of persistence of infection. There were four late deaths. One patient died 2 months after operation, from mycotic pneumonia; a second died suddenly without a clear reason late after a successful reoperation for persistence of infection. Two other patients died late after a reoperation and re-reoperation, respectively, for sterile(?) perivalvular leaks. Overall 3-year survival was 0.87; 3-year, reoperation-free and perivalvular leakage-free survival was 0.38 and 0.37, respectively. Surgical treatment of infective endocarditis resistant to medical treatment is effective in eradicating infection in the majority of cases, even though reoperation may be required in a significant percentage of patients to achieve this. Surgical treatment is mandatory if infection does not subside after 7 days of appropriate antimicrobial therapy and/or if cardiac failure develops. Bioprosthetic and mechanical prosthetic materials show comparable results. |
| Databáze: | OpenAIRE |
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