Optimal Timing of Surgery for Patients with Active Infective Endocarditis

2021 ◽  
Vol 39 (2) ◽  
pp. 197-209
Author(s):  
Takeshi Kitai ◽  
Akiko Masumoto ◽  
Taiji Okada ◽  
Tadaaki Koyama ◽  
Yutaka Furukawa
Keyword(s):  
Infective Endocarditis ◽  
Timing Of Surgery ◽  
Optimal Timing ◽  
Active Infective Endocarditis

scholarly journals Midterm Outcomes of Early Versus Late Surgery for Infective Endocarditis with Neurologic Complications: A Meta-analysis

2020 ◽  
Author(s):  
Yujiro Yokoyama ◽  
Taichiro Goto
Keyword(s):  
Infective Endocarditis ◽  
Meta Analysis ◽  
Perioperative Period ◽  
Timing Of Surgery ◽  
Optimal Timing ◽  
Neurologic Complications ◽  
Recurrence Rates ◽  
Hazard Ratios ◽  
All Cause Mortality ◽  
Secondary Endpoints

Abstract Background: Cerebral infarction (CI) remains one of the most common and fatal complications of infective endocarditis (IE), and the timing of surgery for IE with neurologic complications is controversial. As outcomes beyond the perioperative period have not been assessed with a meta-analysis previously, we conducted a meta-analysis comparing mid- to long-term outcomes of early and late surgery in patients with IE and neurologic complications.Methods: All studies that investigated early and late surgery in patients with IE and neurologic complications were identified. The primary and secondary endpoints were all-cause mortality and recurrence, respectively. Hazard ratios (HRs) for all-cause mortality and recurrence were extracted from each study. Results: Our search identified five eligible studies, which were all observational studies consisting of a total of 624 patients with IE and neurologic complications. Pooled analyses demonstrated that all-cause mortality was similar between the early and late surgery groups (HR [95% confidence interval [CI]]=0.90 [0.49-1.64]; P=0.10; I2=49%). Similarly, the recurrence rates were similar between both groups (HR [95% CI]=1.86 [0.76-4.52]; P=0.43; I2=0%). Conclusions: Our meta-analysis showed similar mortality and recurrent rates between the early and late surgery groups. The optimal timing of surgery should be individualized on a case-to-case basis.

Role of Echocardiography in Guiding the Optimal Timing of Surgery in Infective Endocarditis

2013 ◽  
Vol 15 (4) ◽  
pp. 335-341
Author(s):  
Sagar Mallikethi Reddy ◽  
Sidakpal Panaich ◽  
Luis Afonso
Keyword(s):  
Infective Endocarditis ◽  
Timing Of Surgery ◽  
Optimal Timing

scholarly journals Extracorporeal Membrane Oxygenation as a Bridge to Surgery for Infective Endocarditis Complicated by Aorto-Atrial Fistula and Cardiopulmonary Collapse

2015 ◽  
Vol 42 (5) ◽  
pp. 471-473 ◽  
Author(s):  
Adam M. Noyes ◽  
Bhavadharini Ramu ◽  
Matthew W. Parker ◽  
David Underhill ◽  
Jason A. Gluck
Keyword(s):  
Infective Endocarditis ◽  
Extracorporeal Membrane Oxygenation ◽  
Timing Of Surgery ◽  
Definitive Treatment ◽  
Bridge To Surgery ◽  
Active Infective Endocarditis ◽  
Membrane Oxygenation ◽  
Hemodynamic Compromise ◽  
First Case

The timing of surgery for active infective endocarditis is challenging when patients exhibit mechanical dysfunction and hemodynamic compromise. Extracorporeal membrane oxygenation has been described in treating sepsis but not, insofar as we know, in treating the acute mechanical sequelae that arise from infective endocarditis. We report perhaps the first case that shows the usefulness of extracorporeal membrane oxygenation as a bridge to definitive treatment in a 35-year-old man who had infective endocarditis followed by aorto-atrial fistula and cardiopulmonary collapse.

scholarly journals Midterm outcomes of early versus late surgery for infective endocarditis with neurologic complications: a meta-analysis

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Yujiro Yokoyama ◽  
Taichiro Goto
Keyword(s):  
Infective Endocarditis ◽  
Meta Analysis ◽  
Perioperative Period ◽  
Timing Of Surgery ◽  
Optimal Timing ◽  
Neurologic Complications ◽  
Recurrence Rates ◽  
Hazard Ratios ◽  
All Cause Mortality ◽  
Secondary Endpoints

Abstract Background Cerebral infarction (CI) remains one of the most common and fatal complications of infective endocarditis (IE), and the timing of surgery for IE with neurologic complications is controversial. As outcomes beyond the perioperative period have not been assessed with a meta-analysis previously, we conducted a meta-analysis comparing mid- to long-term outcomes of early and late surgery in patients with IE and neurologic complications. Methods All studies that investigated early and late surgery in patients with IE and neurologic complications were identified. The primary and secondary endpoints were all-cause mortality and recurrence, respectively. Hazard ratios (HRs) for all-cause mortality and recurrence were extracted from each study. Results Our search identified five eligible studies, which were all observational studies consisting of a total of 624 patients with IE and neurologic complications. Pooled analyses demonstrated that all-cause mortality was similar between the early and late surgery groups (HR [95% confidence interval [CI]] = 0.90 [0.49–1.64]; P = 0.10; I2 = 49%). Similarly, the recurrence rates were similar between both groups (HR [95% CI] = 1.86 [0.76–4.52]; P = 0.43; I2 = 0%). Conclusions Our meta-analysis showed similar mortality and recurrent rates between the early and late surgery groups. The optimal timing of surgery should be individualized on a case-to-case basis.

Preoperative stroke in infective endocarditis neither independently affects mortality nor should it affect timing of surgery

2014 ◽  
Vol 62 (S 01) ◽  
Author(s):  
M. Diab ◽  
G. Färber ◽  
M. Walther ◽  
A. Matz ◽  
J. Hedderich ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Timing Of Surgery

scholarly journals GCT-53. CASE OF INTRACRANIAL GROWING TERATOMA SYNDROME WITH DIFFICULTY IN TIMING OF RESECTION

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii339-iii339
Author(s):  
Hidenobu Yoshitake ◽  
Hideo Nakamura ◽  
Yuta Hamamoto ◽  
Yusuke Otsu ◽  
Jin Kikuchi ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Endoscopic Third Ventriculostomy ◽  
Obstructive Hydrocephalus ◽  
Mature Teratoma ◽  
Timing Of Surgery ◽  
Optimal Timing ◽  
Third Ventriculostomy ◽  
Mixed Tumor ◽  
Gland Tumor ◽  
Growing Teratoma Syndrome

Abstract BACKGROUND Intracranial Growing teratoma syndrome(iGTS) is a phenomenon in which a tumor with a teratoma component grows during treatment, and its pathological tissue is often a mature teratoma. Here we report a case of iGTS in which the timing of surgery was determined by tumor markers and changes in tumor size on MRI images. CASE-REPORT: 11-year-old boy with a short stature. He developed a headache and we found a pineal gland tumor on MRI. Due to obstructive hydrocephalus, an endoscopic third ventriculostomy and biopsy were performed. The pathological diagnosis was mature teratoma, but AFP was elevated at 104.2 ng/mL. Considering NGGCT, we started chemoradiation immediately. Despite the declining AFP, it gradually increased, at which point we suspected iGTS. Resection was considered, but at some point tumor growth had stopped, so radiation therapy and a second course of ICE therapy preceded the resection. Thereafter, the tumor was completely removed, and a third course of ICE therapy was performed. DISCUSSION The onset mechanism of iGTS has not been elucidated, and its prediction is difficult. Early resection of the tumor is required, but discontinuation of radiation therapy and side effects of chemotherapy also need to be considered. In our case, resection was performed after normalization of AFP and recovery of myelosuppression. The patient followed an uneventful course, but the timing of resection was controversial. CONCLUSION We experienced a case of iGTS in NGGCT, a mixed tumor with mature teratoma. The optimal timing of the resection was discussed and literature was reviewed.

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