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Surgical outcomes in native valve infectious endocarditis: the experience of the Cardiovascular Surgery Department – Cluj-Napoca Heart Institute
BACKGROUND AND AIMS: The introduction of Duke’s criteria and the improvement of imaging methods has lead to an earlier and a more accurate diagnosis of infectious endocarditis (IE). The options for the best therapeutic approach and the timing of surgery are still a matter of debate and require a clo...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Iuliu Hatieganu University of Medicine and Pharmacy
2015
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4632893/ https://www.ncbi.nlm.nih.gov/pubmed/26609267 http://dx.doi.org/10.15386/cjmed-482 |
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author | MOLNAR, ADRIAN MURESAN, IOAN TRIFAN, CATALIN POP, DANA SACUI, DIANA |
author_facet | MOLNAR, ADRIAN MURESAN, IOAN TRIFAN, CATALIN POP, DANA SACUI, DIANA |
author_sort | MOLNAR, ADRIAN |
collection | PubMed |
description | BACKGROUND AND AIMS: The introduction of Duke’s criteria and the improvement of imaging methods has lead to an earlier and a more accurate diagnosis of infectious endocarditis (IE). The options for the best therapeutic approach and the timing of surgery are still a matter of debate and require a close colaboration between the cardiologist, the infectionist and the cardiac surgeon. METHODS: We undertook a retrospective, descriptive study, spanning over a period of five years (from January 1st, 2007 to December 31st, 2012), on 100 patients who underwent surgery for native valve infectious endocarditis in our unit. RESULTS: The patients’ age varied between 13 and 77 years (with a mean of 54 years), of which 85 were males (85%). The main microorganisms responsible for IE were: Streptococcus Spp. (21 cases – 21%), Staphylococcus Spp. (15 cases – 15%), and Enterococcus Spp. (9 cases – 9%). The potential source of infection was identified in 26 patients (26%), with most cases being in the dental area (16 cases – 16%). The lesions caused by IE were situated in the left heart in 96 patients (96%), mostly on the aortic valve (50 cases – 50%). In most cases (82%) we found preexisting endocardial lesions which predisposed to the development of IE, most of them being degenerative valvular lesions (38 cases – 38%). We performed the following surgical procedures: surgery on a single valve - aortic valve replacement (40 cases), mitral valve replacement (19 cases), mitral valve repair (1 case), surgery on more than one valve – mitral and aortic valve replacement (20 cases), aortic and tricuspid valve replacement (1 case), aortic valve replacement with a mechanical valve associated with mitral valve repair (5 cases), aortic valve replacement with a biological valve associated with mitral valve repair (2 cases), and mitral valve replacement with a mechanical valve combined with De Vega procedure on the tricuspid valve (1 case). In 5 patients (5%) the bacteriological examination of valve pieces excised during surgery was positive. In 3 cases it matched the germ identified in the hemocultures, and in 2 cases it evidenced another bacterium. CONCLUSION: The overall mortality of 5% is well between the limits presented in literature, being higher (30%) in patients who required emergency surgery. For the patients who return into our clinic with prosthetic valve endocarditis, the mortality after surgery was even higher (50%). |
format | Online Article Text |
id | pubmed-4632893 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | Iuliu Hatieganu University of Medicine and Pharmacy |
record_format | MEDLINE/PubMed |
spelling | pubmed-46328932015-11-25 Surgical outcomes in native valve infectious endocarditis: the experience of the Cardiovascular Surgery Department – Cluj-Napoca Heart Institute MOLNAR, ADRIAN MURESAN, IOAN TRIFAN, CATALIN POP, DANA SACUI, DIANA Clujul Med Original Research BACKGROUND AND AIMS: The introduction of Duke’s criteria and the improvement of imaging methods has lead to an earlier and a more accurate diagnosis of infectious endocarditis (IE). The options for the best therapeutic approach and the timing of surgery are still a matter of debate and require a close colaboration between the cardiologist, the infectionist and the cardiac surgeon. METHODS: We undertook a retrospective, descriptive study, spanning over a period of five years (from January 1st, 2007 to December 31st, 2012), on 100 patients who underwent surgery for native valve infectious endocarditis in our unit. RESULTS: The patients’ age varied between 13 and 77 years (with a mean of 54 years), of which 85 were males (85%). The main microorganisms responsible for IE were: Streptococcus Spp. (21 cases – 21%), Staphylococcus Spp. (15 cases – 15%), and Enterococcus Spp. (9 cases – 9%). The potential source of infection was identified in 26 patients (26%), with most cases being in the dental area (16 cases – 16%). The lesions caused by IE were situated in the left heart in 96 patients (96%), mostly on the aortic valve (50 cases – 50%). In most cases (82%) we found preexisting endocardial lesions which predisposed to the development of IE, most of them being degenerative valvular lesions (38 cases – 38%). We performed the following surgical procedures: surgery on a single valve - aortic valve replacement (40 cases), mitral valve replacement (19 cases), mitral valve repair (1 case), surgery on more than one valve – mitral and aortic valve replacement (20 cases), aortic and tricuspid valve replacement (1 case), aortic valve replacement with a mechanical valve associated with mitral valve repair (5 cases), aortic valve replacement with a biological valve associated with mitral valve repair (2 cases), and mitral valve replacement with a mechanical valve combined with De Vega procedure on the tricuspid valve (1 case). In 5 patients (5%) the bacteriological examination of valve pieces excised during surgery was positive. In 3 cases it matched the germ identified in the hemocultures, and in 2 cases it evidenced another bacterium. CONCLUSION: The overall mortality of 5% is well between the limits presented in literature, being higher (30%) in patients who required emergency surgery. For the patients who return into our clinic with prosthetic valve endocarditis, the mortality after surgery was even higher (50%). Iuliu Hatieganu University of Medicine and Pharmacy 2015 2015-07-01 /pmc/articles/PMC4632893/ /pubmed/26609267 http://dx.doi.org/10.15386/cjmed-482 Text en This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (http://creativecommons.org/licenses/by-nc-nd/4.0/) |
spellingShingle | Original Research MOLNAR, ADRIAN MURESAN, IOAN TRIFAN, CATALIN POP, DANA SACUI, DIANA Surgical outcomes in native valve infectious endocarditis: the experience of the Cardiovascular Surgery Department – Cluj-Napoca Heart Institute |
title | Surgical outcomes in native valve infectious endocarditis: the experience of the Cardiovascular Surgery Department – Cluj-Napoca Heart Institute |
title_full | Surgical outcomes in native valve infectious endocarditis: the experience of the Cardiovascular Surgery Department – Cluj-Napoca Heart Institute |
title_fullStr | Surgical outcomes in native valve infectious endocarditis: the experience of the Cardiovascular Surgery Department – Cluj-Napoca Heart Institute |
title_full_unstemmed | Surgical outcomes in native valve infectious endocarditis: the experience of the Cardiovascular Surgery Department – Cluj-Napoca Heart Institute |
title_short | Surgical outcomes in native valve infectious endocarditis: the experience of the Cardiovascular Surgery Department – Cluj-Napoca Heart Institute |
title_sort | surgical outcomes in native valve infectious endocarditis: the experience of the cardiovascular surgery department – cluj-napoca heart institute |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4632893/ https://www.ncbi.nlm.nih.gov/pubmed/26609267 http://dx.doi.org/10.15386/cjmed-482 |
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