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ICVTS on-line discussion A Active infective endocarditis-predictability surgical results

Bakoulev Center for Cardiovascular Surgery, Moscow 121552, Russia

Early surgery for hospital-acquired and community-acquired active infective endocarditis

eComment: In our Center we do not make a distinction between ‘inhospital’ and ‘out-hospital’ endocarditis. The main criterion for the distinction of native infective endocarditis is active and non-active [1].

Since 1977 in the Bakoulev Scientific Center for Cardiovascular Surgery, RAMS, more than 1000 have undergone surgical treatment for active valve infective endocarditis (IE). A long time was needed for the establishment of the correct diagnosis of IE inhibited timely realization of the conception of active IE treatment and/or determined unsuccessfulness of conservative treatment and inadequacy of antibacterial therapy. The majority of patients with IE were operated on because of progressive heart failure, tromboembolism, septic syndrome, and their combination. At hospital stage we lost 13 (7.1%) patients with active IE of the MV and 3 (5.3%) patients with active IE of the TV. The main cause of death was acute heart failure.

Hospital mortality in patients with active IE of the MV was reliablyaffected by the following risk factors:

• IE of fungal etiology
  
• Association of LV EF <51% and non-preserved posterior mitral cusp
  

The development of prosthetic endocarditis in patients with IE of the MV was reliably affected by the following risk factors:

• Staphylococcus aureus in IE etiology
  
• LV EF <51%
  
• Abscesses of the fibrous ring
  
• Association of LV EF <51% and non-preserved posterior mitral cusp
  

The development of prosthetic endocarditis in patients with IE of theTV was reliably affected by:

• NYHA class IV
  
• Other valves involvement
  
• TV replacement with mechanical prostheses
  
• Association of NYHA class IV with IE duration over 2 months
  

The formation of paraprosthetic fistula in patients with IE of the MV was reliably affected by:

• Abscesses of the fibrous ring and mitral-aortic contact
  
• Non-preserved posterior mitral leaflet
  
• Association of NYHA class IV, LV EF <51% and non-preserved posterior mitral leaflet
  

As for the article ‘‘Early Surgery for hospital-acquired and communityacquired active infective endocarditis’’ [2], we were intrigued by the concept of ‘similar criteria, but different treatment’, yet, unfortunately, the differences are not explained in detail. Our attitude towards active IE can be described as aggressive and radical. High activity of IE, abscesses of the FC and extensive lesions of intracardiac structures, multi-organ failure and neurological deficit do not influence hospital mortality, and should not be considered as the reason for the refusal or delay of surgical intervention. Hospital mortality in patients with active IE of AV valves is influenced by the factors characterizing the severity of septic syndrome and dysfunction of hemodynamic status of patients. According to our data, the results of the use of biological stented prostheses do not differ from those of mechanical prostheses and do not provide resistance to the infection.

	References

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1. Von Rein CF, Levy BS, Arbeit DR, Friedland G, Crumpacker CS. Infective endocarditis: an analysis based on strict case definitions. Ann Intern Med 1981; 94:505–518.[Medline]
2. Shibata T, Sasaki Y, Hirai H, Fukui T, Hosono M, Suehiro S. Early surgery for hospital-acquired and community-acquired active infective endocarditis. Interact CardioVasc Thorac Surg 2007; 6:354–358.[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): Leo A. Bockeria Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Bockeria, L. A. Articles by Shamsiev, G.A. Search for Related Content PubMed PubMed Citation Articles by Bockeria, L. A. Articles by Shamsiev, G.A. Related Collections Related Article