Non-bacterial thrombotic endocarditis surgery

non-bacterial thrombotic endocarditis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Homa Najafi, M.D.[2]

Overview

Surgical intervention is not recommended for the management of [disease name].

OR

Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]

OR

The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].

OR

The feasibility of surgery depends on the stage of [malignancy] at diagnosis.

OR

Surgery is the mainstay of treatment for [disease or malignancy].

Indications

• Surgical intervention is not recommended for the management of [disease name].

OR

• Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either:
  • [Indication 1]
  • [Indication 2]
  • [Indication 3]
• The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either:
  • [Indication 1]
  • [Indication 2]
  • [Indication 3]

Surgery

• The feasibility of surgery depends on the stage of [malignancy] at diagnosis.

OR

• Surgery is the mainstay of treatment for [disease or malignancy].

Although not formally evaluated in prospective trials, surgical intervention for NBTE-associated vegetations has been reported and may be considered in select cases where the risk benefit is favorable [11,13,35]. The indications for surgery (vegetation excision or valve replacement) are the same as for infective endocarditis (eg, heart failure, acute valve rupture) but reports suggest that prevention of recurrent embolization is the most common reason for surgery. In contrast to infective endocarditis where complete removal of infected tissue is important, preservation of the valve may be possible in some cases of NBTE. Due to the high risk of recurrence, most case studies also report postoperative anticoagulation when feasible especially in those with a systemic reason for embolization (eg, antiphospholipid syndrome). When considering surgery, the benefits should be weighed against the risks in the context of the life expectancy from the underlying condition