Acute drug-use-related native tricuspid valve infective endocarditis: a non-surgical disease.

As a result of the ongoing opioid epidemic, physicians have encountered increasing rates of drug-use-related native tricuspid valve infective endocarditis (DU-TVIE), a complex multi-faceted disease that is best managed by interdisciplinary teams. Despite the large number of patients with DU-TVIE, there is little data to support the optimal treatment strategy with respect to medical and surgical therapy. The recent introduction of percutaneous mechanical aspiration of tricuspid valve vegetations has added another treatment modality that is also of uncertain benefit. Here we review the literature on the management of DU-TVIE and highlight the multi-step treatment approach developed by the multidisciplinary endocarditis team at the University of Kentucky.

Beyond a team: The comprehensive interdisciplinary endocarditis program in the United States.

Although multidisciplinary teams have been shown to decrease in-hospital mortality for patient with infectious endocarditis, most studies have focused on the inpatient role of these teams, and are primarily based at European tertiary care centers. There is limited literature available on the optimal longitudinal care of this patient population. Here we outline our experience developing an interdisciplinary endocarditis program at the University of Kentucky, which cares for patients from their index hospitalization into the outpatient setting, while also coordinating transfers from regional hospitals and offering education to regional providers.

Low Incidence of Pump-Related Infections in Jarvik 2000 Ventricular Assist Device Recipients with a Subcostal Driveline Exit Site.

Driveline infection has been a persistent problem with mechanical cardiac assist devices. The reported incidence of infection has been low in patients who receive a Jarvik 2000 continuous-flow left ventricular assist device when a skull-pedestal driveline exit site is used. We evaluated whether this is also true when a subcostal driveline exit site is used. We reviewed baseline demographic variables, postimplantation vital signs, laboratory values, and culture results in patients who underwent Jarvik 2000 implantation at our center from April 2000 through October 2009, including follow-up through June 2014. All patients had a subcostal driveline exit site. We defined device-related infection as a positive blood or wound culture associated with a medical or surgical device intervention. Event and time-to-event rates were calculated. Eighty-one patients received 89 Jarvik 2000 devices, all as bridges to transplantation. The median support duration was 69 days (interquartile range, 27-153 d; range, 2-2,249 d). Five superficial driveline infections and one incision-site infection occurred (0.002 events per patient-year of support). The median time from pump implantation to onset of driveline infection was 30 days; the incision-related infection occurred at 44 days. The Jarvik 2000 has a low incidence of infection when implanted with use of a subcostal driveline exit site. The incidence of pump infections is particularly low. Using a subcostal driveline exit site may be as effective in preventing infections as using a skull-pedestal driveline exit site. We detail our findings in this report.