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ICVTS on-line discussion A

Cardiovascular Surgery, Hospital Clinico, University of Barcelona, Barcelona 08036, Spain

What are the long-term results of cardiac valve replacements in left sided endocarditis with a history of i.v. drug abuse?

eComment: The best evidence paper by Alexander Wahba and Dag Nordhaug [1] is of great interest as it addresses a critical issue, namely the actual behaviour of patients undergoing valve replacement for acute infective endocarditis with a history of drug abuse with or without associated HIV infection. It seems clear that the critical point is the preoperative condition of the patient and in which way his/her addiction has to be managed. Crude in-hospital mortality remains high and persistent addiction is the most important factor in the follow-up. Our own data support this statement. We had a significant mortality in the follow-up at three years, but survival remained stable beyond five years and up to ten years. This may represent a combination of strict follow-up that includes efforts in the control of addiction and social reinsertion of patients. An additional point is that valve replacement device ‘per se’ does not influence survival but this needs further refinement as the actual number of cases is not large precluding more powerful conclusions. In our own experience, HIV infection did not result in reduced mortality and this has been more significant in the past ten years due to availability of HAART regimens which have been found to increase survival.

The point has been well taken by Wahba and Nordhaug in this review of the literature. I believe that their comments are very appropriate in this setting. The problem discussed in their paper is not strictly surgical and includes psychological counselling and social reinsertion. I have enjoyed reading this paper which brings to the reader a good review of this serious social topic.

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1. Wahba A, Nordhaug D. What are the long-term results of cardiac valve replacements in left sided endocarditis with a history of i.v. drug abuse? Interact CardioVasc Thorac Surg doi:10.1510/icvts.2006.135947.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Carlos A. Mestres Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Mestres, C. A. Search for Related Content PubMed PubMed Citation Articles by Mestres, C. A. Related Collections Related Article