Endocarditis surgical indications
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Endocarditis Microchapters |
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Diagnosis |
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Treatment |
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2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease |
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Case Studies |
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Endocarditis surgical indications On the Web |
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Risk calculators and risk factors for Endocarditis surgical indications |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Overview
Early valve surgery should be scheduled when there is heart failure due to the valve dysfunction, left-sided infective endocarditis due to Staphylococcus aureus, fungal or highly resistant organisms, or a heart block, annular or aortic abscess or destructive lesions. Other indications include persistent bacteremia or fever 5 to 7 following the initiation of the antibiotics, relapse of the infection depsite a complete course of antibiotics in prosthetic valve endocarditis when no portal of infection can be identified, recurrent emboli and persistent vegetations despite antibiotic therapy, and mobile vegetations with a length more than 10 mm in native valve endocarditis.
Indications
Indications for surgical debridement of vegetations and infected perivalvular tissue, with valve replacement or repair as needed are listed below:[1]
- Moderate to severe congestive heart failure due to valve dysfunction
- Unstable valve prosthesis
- Uncontrolled infection for > 1–3 week despite maximal antimicrobial therapy
- Persistent bacteremia
- Fungal endocarditis
- Relapse after optimal therapy in a prosthetic valve
- Vegetation in Situ
- Prosthetic valve endocarditis with perivalvular invasion
- Endocarditis caused by Pseudomonas aeruginosa or other gram-negative bacilli that has not responded after 7–10 days of maximal antimicrobial therapy
- Perivalvular extension of infection and abscess formation
- Staphylococcal infection of prosthesis
- Persistent fever (culture negative)
- Large vegetation (>10 mm is associated with an increased risk of embolism)
- Relapse after optimal therapy in a native valve
- Vegetations that obstruct the valve orifice
- Onset of AV block
2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease (DO NOT EDIT)[2]
Indications for Surgery for Native Valve Endocarditis (DO NOT EDIT)[2]
| Class I |
| "1. Decisions about timing of surgical intervention should be made by a multispecialty Heart Valve Team of cardiology, cardiothoracic surgery, and infectious disease specialists (301). (Level of Evidence: B) " |
| "2. Early surgery (during initial hospitalization before completion of a full therapeutic course of antibiotics) is indicated in patients with IE who present with valve dysfunction resulting in symptoms of heart failure (342-347). (Level of Evidence: B) " |
| "3. Early surgery (during initial hospitalization before completion of a full therapeutic course of antibiotics) is indicated in patients with left-sided IE caused by Staphylococcus aureus, fungal, or other highly resistant organisms (347-354). (Level of Evidence: B) " |
| "4. Early surgery (during initial hospitalization before completion of a full therapeutic course of antibiotics) is indicated in patients with IE complicated byheart block, annular or aortic abscess, or destructive penetrating lesions (347, 355-359). (Level of Evidence: B) " |
| "5. Early surgery (during initial hospitalization before completion of a full therapeutic course of antibiotics) for IE is indicated in patients with evidence of persistent infection as manifested by persistent bacteremia or fevers lasting longer than 5 to 7 days after onset of appropriate antimicrobial therapy (347, 352, 353, 360-362). (Level of Evidence: B) " |
| "6. Surgery is recommended for patients with prosthetic valve endocarditis and relapsing infection (defined as recurrence of bacteremia after a complete course of appropriate antibiotics and subsequently negative blood cultures) without other identifiable source for portal of infection. (Level of Evidence: C) " |
| "7. Complete removal of pacemaker or defibrillator systems, including all leads and the generator, is indicated as part of the early management plan in patients with IE with documented infection of the device or leads (363-366). (Level of Evidence: B) "
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| Class IIa |
| "1. Complete removal of pacemaker or defibrillator systems, including all leads and the generator, is reasonable in patients with valvular IE caused by Staphylococcus aureus or fungi, even without evidence of device or lead infection (363-366). (Level of Evidence: B)" |
| "2. Complete removal of pacemaker or defibrillator systems, including all leads and the generator, is reasonable in patients undergoing valve surgery for valvular IE. (Level of Evidence: C) " |
| "3.Early surgery (during initial hospitalization before completion of a full therapeutic course of antibiotics) is reasonable in patients with IE who present with recurrent emboli and persistent vegetations despite appropriate antibiotic therapy (302, 367, 368). (Level of Evidence: B)" |
| Class IIb |
| "1. Early surgery (during initial hospitalization before completion of a full therapeutic course of antibiotics) may be considered in patients with native valve endocarditis who exhibit mobile vegetations greater than 10 mm in length (with or without clinical evidence of embolic phenomenon) (302, 367, 368). (Level of Evidence: B)" |
Indications for Surgery for Prosthetic Valve Endocarditis (DO NOT EDIT) [3]
| Class I |
| "1. Consultation with a cardiac surgeon is indicated for patients with infective endocarditis of a prosthetic valve. (Level of Evidence: C)" |
| "2. Surgery is indicated for patients with infective endocarditis of a prosthetic valve who present with heart failure. (Level of Evidence: B)" |
| "3. Surgery is indicated for patients with infective endocarditis of a prosthetic valve who present with dehiscence evidenced by cine fluoroscopy or echocardiography. (Level of Evidence: B)" |
| "4. Surgery is indicated for patients with infective endocarditis of a prosthetic valve who present with evidence of increasing obstruction or worsening regurgitation. (Level of Evidence: C)" |
| "5. Surgery is indicated for patients with infective endocarditis of a prosthetic valve who present with complications (e.g., abscess formation). (Level of Evidence: C)" |
| Class III |
| "1. Routine surgery is not indicated for patients with uncomplicated infective endocarditis of a prosthetic valve caused by first infection with a sensitive organism. (Level of Evidence: C)" |
| Class IIa |
| "1. Surgery is reasonable for patients with infective endocarditis of a prosthetic valve who present with evidence of persistent bacteremia or recurrent emboli despite appropriate antibiotic treatment. (Level of Evidence: C)" |
| "2. Surgery is reasonable for patients with infective endocarditis of a prosthetic valve who present with relapsing infection. (Level of Evidence: C)" |
References
- ↑ 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.
- ↑ 2.0 2.1 Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA; et al. (2014). "2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines". Circulation. 129 (23): 2440–92. doi:10.1161/CIR.0000000000000029. PMID 24589852.
- ↑ Bonow RO, Carabello BA, Chatterjee K; et al. (2008). "2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". Circulation. 118 (15): e523–661. doi:10.1161/CIRCULATIONAHA.108.190748. PMID 18820172. Unknown parameter
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