Endocarditis surgical treatment: Difference between revisions
No edit summary |
No edit summary |
||
| Line 13: | Line 13: | ||
*Repair or replace damaged valves | *Repair or replace damaged valves | ||
*Repair associated pathology such as septal defect, fistulas | *Repair associated pathology such as septal defect, fistulas | ||
Normal 0 false false false EN-US X-NONE X-NONE MicrosoftInternetExplorer4 ==Aortic Valve - Surgical Options== | |||
If the infection limited is limited to the leaflets, then replace the aortic valve. | |||
If the infection extends to anulus or beyond, then debride the infected tissues, drain any abscesses to the pericardial sac and replace the aortic root. | |||
==Atrioventricular Valve - Surgical Options== | |||
If the infection is limited to the leaflets, then perform a vegectomy, repair perforations, and perform a reduction annuloplasty | |||
If the infection extends to the anulus or beyond, then perform valve replacement, debride and abliterate abscesses. In some cases the tricuspid valve may be excised, but 20-30% of patients will develop [[congestive heart failure]]. | |||
==Surgical Outcomes== | |||
Operative mortality is 15 - 20%. The development of an infection of a prosthetic valve during operation for [[endocarditis|native valve endocarditis]] is 4%, it is higher (12 - 16%) if active [[endocarditis]] is present at the time of the surgery. Late survival at 5 years for [[endocarditis|native valve endocarditis]] is 70 - 80% and for [[endocarditis|prosthetic valve endocarditis]] is 50 - 80%.<ref name= Baddour>{{cite journal | author = Baddour Larry M., Wilson Walter R., Bayer Arnold S., Fowler Vance G. Jr, Bolger Ann F., Levison Matthew E., Ferrieri Patricia, Gerber Michael A., Tani Lloyd Y., Gewitz Michael H., Tong David C., Steckelberg James M., Baltimore Robert S., Shulman Stanford T., Burns Jane C., Falace Donald A., Newburger Jane W., Pallasch Thomas J., Takahashi Masato, Taubert Kathryn A.| title = Infective Endocarditis: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Statement for Healthcare Professionals From the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association-Executive Summary: Endorsed by the Infectious Diseases Society of America. | journal = Circulation | volume = 111 | issue = 23 | pages = 3167-84 | year = 2005 | id = PMID 15956145 }}</ref> | |||
==References== | ==References== | ||
Revision as of 01:34, 21 March 2011
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Associate Editors-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Please Join in Editing This Page and Apply to be an Editor-In-Chief for this topic: There can be one or more than one Editor-In-Chief. You may also apply to be an Associate Editor-In-Chief of one of the subtopics below. Please mail us [3] to indicate your interest in serving either as an Editor-In-Chief of the entire topic or as an Associate Editor-In-Chief for a subtopic. Please be sure to attach your CV and or biographical sketch.
Principles of Surgical Treatment of Endocarditis[1]
- Excise all infected valve tissue
- Drain and debride abscess cavities
- Repair or replace damaged valves
- Repair associated pathology such as septal defect, fistulas
Normal 0 false false false EN-US X-NONE X-NONE MicrosoftInternetExplorer4 ==Aortic Valve - Surgical Options==
If the infection limited is limited to the leaflets, then replace the aortic valve.
If the infection extends to anulus or beyond, then debride the infected tissues, drain any abscesses to the pericardial sac and replace the aortic root.
Atrioventricular Valve - Surgical Options
If the infection is limited to the leaflets, then perform a vegectomy, repair perforations, and perform a reduction annuloplasty
If the infection extends to the anulus or beyond, then perform valve replacement, debride and abliterate abscesses. In some cases the tricuspid valve may be excised, but 20-30% of patients will develop congestive heart failure.
Surgical Outcomes
Operative mortality is 15 - 20%. The development of an infection of a prosthetic valve during operation for native valve endocarditis is 4%, it is higher (12 - 16%) if active endocarditis is present at the time of the surgery. Late survival at 5 years for native valve endocarditis is 70 - 80% and for prosthetic valve endocarditis is 50 - 80%.[1]
References
- ↑ 1.0 1.1 Baddour Larry M., Wilson Walter R., Bayer Arnold S., Fowler Vance G. Jr, Bolger Ann F., Levison Matthew E., Ferrieri Patricia, Gerber Michael A., Tani Lloyd Y., Gewitz Michael H., Tong David C., Steckelberg James M., Baltimore Robert S., Shulman Stanford T., Burns Jane C., Falace Donald A., Newburger Jane W., Pallasch Thomas J., Takahashi Masato, Taubert Kathryn A. (2005). "Infective Endocarditis: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Statement for Healthcare Professionals From the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association-Executive Summary: Endorsed by the Infectious Diseases Society of America". Circulation. 111 (23): 3167–84. PMID 15956145.