Surgical management of infective endocarditis associated with cerebral complications

: Infective Endocarditis (IE), a known complication of hemodialysis (HD), has recently been categorized as Healthcare-Associated Infective Endocarditis (HAIE). Single pathogen bacteremia is common, polymicrobial endocardial infection is rare in this cohort of the patients. We report a case of endocarditis caused by Enterococcus faecalis (E. faecalis) and Burkholderia cepacia (B. cepacia), a first ever reported combination of a usual and an unusual organism, respectively, in a patient on HD. Clinical presentation of the patient, its complicated course ,medical and surgical management ,along with microbial and echocardiographic findings is presented herein. The authors believe that presentation of this case of HAIE may benefit and contribute positively to cardiac science owing to the rare encounter of this organism as a pathogen in infective endocarditis and the difficulties in treating it.

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Surgical management for active infective endocarditis: A single hospital 10 years experience

Indian Journal of Thoracic and Cardiovascular Surgery ◽

10.1007/s12055-008-0016-2 ◽

2008 ◽

Vol 24 (2) ◽

pp. 120-123

Author(s):

Rasoul Azarfarin ◽

Azin Alizadehasl ◽

Farnaz Sepasi ◽

Medical Student

Keyword(s):

Infective Endocarditis ◽

Surgical Management ◽

Active Infective Endocarditis

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Abstract 18110: Impact of Stroke Severity on Clinical Outcomes in Patients who had Infective Endocarditis With Cerebral Complications

Circulation ◽

10.1161/circ.130.suppl_2.18110 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Ryosuke Murai ◽

Shunsuke Funakoshi ◽

Shuichiro Kaji ◽

Yasuhiro Sasaki ◽

Kitae Kim ◽

...

Keyword(s):

Infective Endocarditis ◽

Clinical Outcomes ◽

Neurological Deficit ◽

Treatment Strategy ◽

Conventional Treatment ◽

Hospital Death ◽

Stroke Severity ◽

Severe Stroke ◽

Cerebral Complications ◽

Stroke Group

Background: The treatment strategy in active infective endocarditis (IE) with cerebral complications still remains unclear. We sought to analyze the association of the neurological deficit level with the clinical outcomes in IE patients with stroke. Methods and Results: Clinical data were retrospectively reviewed in 141 consecutive patients with active left-sided IE with cerebral complications. To evaluate the severity of stroke, the National Institute of Health Stroke Scale (NIHSS) was assessed in all patients on admission. There were 116 (82%) patients with cerebral infarction including 9 hemorrhagic infarctions and 57 (40%) patients with cerebral hemorrhage. We divided the patients according to NIHSS; severe stroke group (NIHSS>16: n=19) and non-severe stroke group (NIHSS≤16: n=122). Early surgery in the active phase (within 2 weeks after the initial diagnosis) was performed in 64 patients (6 severe stroke group and 58 non-severe stroke group), and the conventional treatment strategy was applied in 77 patients (13 severe stroke group and 64 non-severe stroke group). In the conventional treatment group, 37 patients (36 severe stroke group and 1 non-severe stroke group) underwent late surgical intervention. A mean follow-up period was 4.5 years. In-hospital death was significantly lower in non-severe stroke group (12% versus 53%, p<0.001). In addition, the freedom rate from IE-related death was significantly higher in patients with non-severe stroke than those with severe stroke (84±4 % versus 37±13 % at 5-year, p<0.001). Multivariate Cox proportional hazard analysis showed that NIHSS (HR=1.074; 95% CI 1.042-1.107: p<0.001), logistic EuroSCORE (HR=1.026; 95% CI 1.010-1.042: p=0.002), conventional treatment (HR=3.478; 95% CI 1.477-8.193: p=0.004), and aortic valve involvement (HR=3.091; 95% CI 1.460-6.546: p=0.003) were significantly associated with IE-related mortality (p<0.001). Conclusions: Severity of stroke was strongly associated with clinical outcomes in IE patients with cerebral complications. Therapeutic strategy for IE patients with stroke might have to be customized according to severity of neurological deficit.

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Surgical management of Staphylococcus capitis prosthetic valve infective endocarditis: Retrospective review of a 10-year single center experience and review of the literature

Journal of Infection and Public Health ◽

10.1016/j.jiph.2020.09.010 ◽

2020 ◽

Vol 13 (11) ◽

pp. 1705-1709

Author(s):

Vincent Tchana-Sato ◽

Gregory Hans ◽

Frederic Frippiat ◽

Ines Zekhnini ◽

Raluca Dulgheru ◽

...

Keyword(s):

Infective Endocarditis ◽

Surgical Management ◽

Retrospective Review ◽

Prosthetic Valve ◽

Review Of The Literature ◽

Single Center ◽

Single Center Experience ◽

Staphylococcus Capitis

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Early and intermediate outcomes for surgical management of infective endocarditis

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-019-1029-1 ◽

2019 ◽

Vol 14 (1) ◽

Cited By ~ 1

Author(s):

Lindsay Volk ◽

Nina Verghis ◽

Antonio Chiricolo ◽

Hirohisa Ikegami ◽

Leonard Y. Lee ◽

...

Keyword(s):

Infective Endocarditis ◽

Hospital Mortality ◽

Surgical Management ◽

Surgical Intervention ◽

Medical Center ◽

Academic Medical Center ◽

Retrospective Chart Review ◽

Patient Death ◽

Intermediate Outcomes ◽

Uncertain Outcomes

Abstract Objective The treatment of active infective endocarditis (IE) presents a clinical dilemma with uncertain outcomes. This study sets out to determine the early and intermediate outcomes of patients treated surgically for active IE at an academic medical center. Methods A retrospective chart review was conducted to identify patients who underwent surgical intervention for IE at our institution from July 1st, 2011 to June 30th, 2018. In-patient records were examined to determine etiology of disease, surgical intervention type, postoperative complications, length of stay (LOS), 30-day in-hospital mortality, and 1-year survival. Results Twenty-five patients underwent surgical intervention for active IE. The average age of the patients was 47 ± 14 years old and most of the patients were male (N = 15). The majority of the patients had the mitral valve replaced (N = 10), with the remaining patients having tricuspid (N = 8) and aortic (N = 7) valve replacements. The etiology varied and included intravenous drug use (IVDU), and presence of transvenous catheters. The 30-day in-hospital mortality was 4% with 1 patient death and the 1-year survival was 80%. The average LOS was 27 days ±15 and the longest LOS was 65 days. Conclusions Surgical management of IE can be difficult and challenging however mortality can be minimized with acceptable morbidity. The most common complication was CVA. The average LOS is longer than traditional adult cardiac surgery procedures and the recurrence rate of valvular infection is not minimal especially if the underlying etiology is IVDU.

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