Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.887
Filtrar
1.
Braz J Cardiovasc Surg ; 37(6): 829-835, 2022 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-36259995

RESUMO

INTRODUCTION: Infective endocarditis is a disease that progresses with morbidity and mortality, afecting 3-10 out of 100,000 people per year. We conducted this study to review the early outcomes of surgical treatment of infective endocarditis. METHODS: In this retrospective study, 122 patients who underwent cardiac surgery for infective endocarditis in our clinic between November 2009 and December 2020 were evaluated. Patients were divided into two groups according to in-hospital mortality. Demographic, echocardiographic, laboratory, operative, and postoperative data of the groups were compared. RESULTS: Between November 3, 2009, and December 7, 2020, 122 patients were operated for infective endocarditis in our hospital. Emergency surgery was performed in nine (7.3%) patients. In-hospital mortality occurred in 23 (18.9%) patients, and 99 (81.1%) patients were discharged. In-hospital mortality was related with older age, presence of periannular abscess, New York Heart Association class 3 or 4 symptoms, low albumin level, high alanine aminotransferase level, and longer cross-clamping time (P<0.05 for all). CONCLUSION: The presence of paravalvular abscess was the most important prognostic factor in patients operated for infective endocarditis.


Assuntos
Endocardite Bacteriana , Endocardite , Próteses Valvulares Cardíacas , Humanos , Abscesso/cirurgia , Estudos Retrospectivos , Endocardite Bacteriana/complicações , Endocardite Bacteriana/cirurgia , Endocardite/cirurgia , Mortalidade Hospitalar
2.
Am J Cardiol ; 185: 80-86, 2022 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-36280471

RESUMO

The increase of intravenous drug use has led to an increase in right-sided infective endocarditis and its complications including septic pulmonary embolism. The objective of this study was to compare the outcomes of tricuspid valve (TV) operations in patients with drug-use infective endocarditis (DU-IE) complicated by septic pulmonary emboli (PE). Hospitalizations for DU-IE complicated by septic PE were identified from the National Inpatient Sample from 2002 to 2019. Outcomes of patients who underwent TV operations were compared with medical management. The primary outcome was the incidence of major adverse cardiovascular events (MACEs), defined as in-hospital mortality, myocardial infarction, stroke, cardiogenic shock, or cardiac arrest. An inverse probability of treatment weighted analysis was utilized to adjust for the differences between the cohorts. A total of 9,029 cases of DU-IE with septic PE were identified (mean age 33.6 years), of which 818 patients (9.1%) underwent TV operation. Surgery was associated with a higher rate of MACE (14.5% vs 10.8%, p <0.01), driven by a higher rate of cardiogenic shock (6.1% vs 1.2%, p <0.01) but a lower rate of mortality (2.7% vs 5.7%, p <0.01). Moreover, TV operation was associated with an increased need for permanent pacemakers, blood transfusions, and a higher risk of acute kidney injury. In the inverse probability treatment weighting analysis, TV operation was associated with an increased risk for MACE driven by a higher rate of cardiogenic shock and cardiac arrest, but a lower rate of mortality when compared with medical therapy alone. In conclusion, TV operations in patients with DU-IE complicated by septic PE are associated with an increased risk for MACE but a decreased risk of mortality. Although surgical management may be beneficial in some patients, alternative options such as percutaneous debulking should be considered given the higher risk.


Assuntos
Endocardite Bacteriana , Endocardite , Parada Cardíaca , Transtornos Relacionados ao Uso de Substâncias , Humanos , Adulto , Valva Tricúspide/cirurgia , Choque Cardiogênico/complicações , Endocardite Bacteriana/complicações , Endocardite Bacteriana/epidemiologia , Endocardite Bacteriana/cirurgia , Endocardite/complicações , Endocardite/epidemiologia , Endocardite/cirurgia , Transtornos Relacionados ao Uso de Substâncias/complicações , Parada Cardíaca/complicações , Resultado do Tratamento
3.
Kyobu Geka ; 75(12): 1007-1011, 2022 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-36299154

RESUMO

Trifecta valve is made from single bovine pericardial sheet, which is externally mounted on a titanium stent. This valve design provides good hemodynamic performance and wide effective orifice area. However, there have been some reports of early structural valve dysfunction which caused acute heart failure. Case 1:An 80-year-old man who had undergone aortic valve replacement (AVR) using Trifecta 21 mm five years ago. He presented with fever and diastolic murmur. Echocardiography showed prosthetic valve regurgitation, and the patient later developed prosthetic valve endocarditis. Case 2:An 80-year-old woman who had undergone AVR using Trifecta GT 21 mm two years ago developed sudden chest pain and dyspnea, prosthetic valve regurgitation. Both patients underwent re-AVR with a new bioprosthetic valve via re-sternotomy. Large tear was found in the right coronary cusp of the Trifecta in both cases. During Trifecta accomodation, we should avoid oversizing, and check the position of coronary ostia and sinus of Valsalva. Secure late outcome of Trifecta GT remains unproven and its use still needs caution.


Assuntos
Insuficiência da Valva Aórtica , Estenose da Valva Aórtica , Bioprótese , Endocardite Bacteriana , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Masculino , Feminino , Humanos , Bovinos , Animais , Idoso de 80 Anos ou mais , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/cirurgia , Titânio , Endocardite Bacteriana/cirurgia , Desenho de Prótese , Hemodinâmica , Estenose da Valva Aórtica/cirurgia , Resultado do Tratamento
4.
Artigo em Inglês | MEDLINE | ID: mdl-36218822

RESUMO

Mitral valve repair for endocarditis in an acute setting is still challenging due to difficulties in debriding friable tissue and in leaving enough non-infected tissue for reconstruction. Endoscopic approaches for complex mitral valve procedures via a minimally invasive approach have been reported from high-volume programs. However, the role of endoscopic mitral valve surgery for acute infective endocarditis has not been clearly defined. We report our technique of endoscopic mitral valve repair using the cavitron ultrasonic surgical aspirator system for active endocarditis. The cavitron ultrasonic surgical aspirator with a low power setting provides enough debridement of the infective tissue and leaves healthy tissue adequate for repair under a totally endoscopic vision.


Assuntos
Endocardite Bacteriana , Endocardite , Implante de Prótese de Valva Cardíaca , Humanos , Valva Mitral/diagnóstico por imagem , Valva Mitral/cirurgia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Ultrassom , Resultado do Tratamento , Endocardite/cirurgia , Endocardite Bacteriana/diagnóstico por imagem , Endocardite Bacteriana/cirurgia
6.
Kyobu Geka ; 75(10): 763-767, 2022 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-36155566

RESUMO

Infective endocarditis is an infection of the endocardium that can cause major complications. While surgery may reduce complications and improve survival, the surgery is of high risk and has a high mortality rate. Indications for early surgical treatment include advanced heart failure, refractory infection, and embolism. The most prominent form of heart failure associated with infective endocarditis is valve regurgitation owing to valve destruction caused by the infection. If the infection is not resolved after 3-5 days of antimicrobial therapy, the diagnosis of refractory infection should be made, and early surgical intervention should be performed. The most frequent embolism is of the central nervous system. Guidelines in Japan state that surgery should not be postponed in the case of cerebral infarction and recommend waiting four weeks for open heart surgery in the case of new intracranial hemorrhage. In addition, the presence of infected cerebral aneurysms should not be overlooked during early surgical intervention. Infected cerebral aneurysms are diagnosed using computed tomography angiography or magnetic resonance angiography. Finally, it is important to consider the timing of surgery based on day-to-day changes in the patient's condition, including onset of heart failure, infection status, and vegetation expansion.


Assuntos
Aneurisma Infectado , Anti-Infecciosos , Embolia , Endocardite Bacteriana , Endocardite , Insuficiência Cardíaca , Aneurisma Intracraniano , Embolia/etiologia , Endocardite/complicações , Endocardite/cirurgia , Endocardite Bacteriana/complicações , Endocardite Bacteriana/diagnóstico por imagem , Endocardite Bacteriana/cirurgia , Insuficiência Cardíaca/complicações , Humanos , Aneurisma Intracraniano/complicações
7.
Kyobu Geka ; 75(10): 768-774, 2022 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-36155567

RESUMO

Aortic root pseudoaneurysm is often derived from suture sites after aortic root replacement on the basis of connective tissue disease, aortitis, or prosthetic valve endocarditis. Preoperative computed tomography (CT) and echocardiography are useful not only for diagnosing a pseudoaneurysm but also for planning to repair it. Redo aortic root replacement is necessary to repair it in most cases. When a giant pseudoaneurysm is close to a sternal posterior wall, resternotomy may be challenging. In such a case, precedent cardiopulmonary bypass with left ventricular apical vent under mild-moderate hypothermia is useful to control bleeding during resternotomy. Regarding graft selection, cryopreserved homograft is effective for repairing pseudoaneurysm in an active infectious phase, but modified Bentall procedure may be still considerable to expect long-term durability if infection is well controlled by preoperative sufficient antibiotic treatment and intraoperative debridement. In the author's institute, 45 patients with aortic root pseudoaneurysm underwent surgical repair since 2011. Thirty cases (67%) was infectious. Thirty-six patients( 80%) underwent aortic root replacement, including homograft in 14 patients and modified Bentall procedure in 22 patients. All the patients survived at discharge, and 1-year and 5-year survival were 96.8% and 74.9%, respectively. Preoperative infectious status and graft selection did not significantly affect remote-phase survival.


Assuntos
Falso Aneurisma , Endocardite Bacteriana , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/cirurgia , Antibacterianos , Valva Aórtica/transplante , Endocardite Bacteriana/cirurgia , Humanos
8.
Kyobu Geka ; 75(11): 979-981, 2022 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-36176260

RESUMO

We experienced a case of infective endocarditis caused by Abiotrophia defectiva in which aortic, mitral, and tricuspid valve surgery was performed. Even if blood cultures are negative, it is important to treat patients with endocarditis considering the possibility that some organisms are difficult to detect via conventional blood culture. Embolism is a complication that should not be overlooked in cases of infective endocarditis, particularly those caused by Abiotrophia defectiva, which tends to cause embolism. As the patient had splenic and cerebral infarction preoperatively, early surgical intervention was performed to prevent further embolisms, and the patient's postoperative course was excellent.


Assuntos
Abiotrophia , Endocardite Bacteriana , Endocardite , Infecções por Bactérias Gram-Positivas , Endocardite/complicações , Endocardite Bacteriana/complicações , Endocardite Bacteriana/diagnóstico por imagem , Endocardite Bacteriana/cirurgia , Infecções por Bactérias Gram-Positivas/cirurgia , Humanos
9.
J Card Surg ; 37(11): 3713-3719, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36073065

RESUMO

BACKGROUND AND AIM: To determine the factors contributing to successful mitral valve repair (MVP) and to discuss the effect of complex techniques on the durability of MVP for active infective endocarditis (IE) affecting the mitral valve. METHODS: One hundred and eighty-seven patients were enrolled; 39.6% underwent mitral valve replacement (MVR) and 60.4% underwent MVP. We used logistic regression to identify influencing factors of the choice of surgical technique. The results were compared between groups and subgroups after propensity score matching (PSM). RESULTS: Risk factors for MVR included poor valve quality (odds ratio [OR] 23.3, p = .001), a large defect after debridement (OR 16.4, p < .001), and heavy valve infection (OR 3.7, p = .027). After PSM, we did not find a significant difference in the frequency of major postoperative complications or the in-hospital or postdischarge death rate. The reintervention rate for MVP was significantly higher than that for MVR (p = .047). Subgroup analysis found a significant relationship between the use of a complex repair technique and the need for reoperation (p = .020). CONCLUSIONS: The choice of valve repair or replacement for patients with active IE affecting the mitral valve was influenced by the intraoperative characteristics of the infected valve rather than the severity of systemic infection or overall health status. The choice of surgical treatment strategy had no effect on major postoperative complications, in-hospital mortality, or medium-term survival. However, the medium-term durability of MVP was poorer than that of MVR. The use of the patch technique for free margins or extensive leaflet defects was associated with a need for reintervention.


Assuntos
Endocardite Bacteriana , Endocardite , Implante de Prótese de Valva Cardíaca , Insuficiência da Valva Mitral , Assistência ao Convalescente , Endocardite/etiologia , Endocardite/cirurgia , Endocardite Bacteriana/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Valva Mitral/cirurgia , Insuficiência da Valva Mitral/cirurgia , Alta do Paciente , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Resultado do Tratamento
10.
J Card Surg ; 37(11): 3964-3966, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36116048

RESUMO

Surgical treatment of infective endocarditis remains a challenge, with concerns of optimal prosthesis selection and risks of recurrent infection remaining paramount. The pulmonary autograft has unique features which may make it the ideal aortic valve substitute, especially in infectious endocarditis. We describe strategic considerations and technical details in performing a Ross procedure in a young patient with acute aortic valve endocarditis.


Assuntos
Endocardite Bacteriana , Endocardite , Implante de Prótese de Valva Cardíaca , Valva Pulmonar , Valva Aórtica/cirurgia , Autoenxertos , Endocardite/cirurgia , Endocardite Bacteriana/cirurgia , Humanos , Valva Pulmonar/transplante , Transplante Autólogo , Resultado do Tratamento
11.
Wiad Lek ; 75(6): 1789-1791, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35962699

RESUMO

In patients with congenital heart disease (CHD), presence of intracardiac shunt can be a substrate for infective endocarditis (IE). Our aim was to highlight that this diagnosis should always be suspected when CHD patients present with persistent fever. In this case report, we describe the case of a 33-year-old female patient with a history of perimembranous ventricular septal defect (VSD) who presented to the hospital with persistent fever. Six months ago, the patient had undergone a tooth extraction under antibiotic prophylaxis. The transthoracic echocardiogram revealed a mobile mass, consistent with vegetation in the tricuspid valve. The blood cultures grew Streptococcus mitis. Antimicrobial treatment was initiated for IE. Symptoms and inflammation markers improved, but the patient relapsed in the 4th week of treatment. Transesophageal echocardiogram revealed a new mobile vegetation attached to the right ventricular outflow tract and the patient was referred for surgery. Her postoperative course was uneventful.


Assuntos
Endocardite Bacteriana , Comunicação Interventricular , Adulto , Antibioticoprofilaxia , Ecocardiografia/efeitos adversos , Endocardite Bacteriana/complicações , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/cirurgia , Feminino , Comunicação Interventricular/complicações , Comunicação Interventricular/diagnóstico por imagem , Comunicação Interventricular/cirurgia , Humanos , Valva Tricúspide/cirurgia
14.
Curr Opin Crit Care ; 28(5): 503-512, 2022 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-35942691

RESUMO

PURPOSE OF REVIEW: The incidence of infective endocarditis (IE) is increasing worldwide, resulting in a higher number of patients with IE being admitted to intensive care units (ICU). Nearly half of patients with IE develop a complication during their clinical course. However, few well conducted studies or reviews are devoted to critically ill IE patients. This review discusses the contemporary perioperative and intensive care literature. RECENT FINDINGS: IE epidemiology is changing towards elderly and frail patients. ICU patients are at risk of risk of developing IE because they are often in a pro-inflammatory state and many also have several indwelling catheters, which favors infection. Increased performance and recent advances in cardiac imaging allow for easier diagnosis of EI, but the applicability of these techniques to ICU patients is still relatively limited. New developments in antibiotic treatment and adjunctive therapies are explored further in this review. SUMMARY: The lack of evidence on ICU patients with IE highlights the critical importance of multidisciplinary decision-making and the need for further research.


Assuntos
Endocardite Bacteriana , Endocardite , Idoso , Cuidados Críticos , Estado Terminal , Endocardite/diagnóstico , Endocardite/epidemiologia , Endocardite/terapia , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/cirurgia , Humanos , Unidades de Terapia Intensiva
17.
PLoS One ; 17(7): e0266820, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35900987

RESUMO

BACKGROUND: Postoperative sepsis is an important cause of morbidity and mortality in patients with infective endocarditis undergoing surgical therapy. Blood purification using hemoadsorption therapy shows promising results in the treatment of sepsis. In this study, the clinical effects of intraoperative hemoadsorption in high-risk patients with infective endocarditis were evaluated. METHODS: Eligible candidates were high-risk patients with infective endocarditis undergoing cardiac surgery between January 2014 and December 2019. Patients with intraoperative hemoadsorption (hemoadsorption) were compared to patients without hemoadsorption (control). The endpoints were the incidence of postoperative sepsis, sepsis-associated death and in-hospital mortality. Additionally, postoperative vasopressor need, systemic vascular resistance indices and Sequential Organ Failure Assessment (SOFA) scores were compared. RESULTS: After propensity score matching, 70 high-risk patients were included. Postoperative sepsis occurred in 14 patients in the hemoadsorption group and in 16 patients in the control group, p = 0.629. Four patients died due to postoperative sepsis in the hemoadsorption group, while 11 postoperative septic patients died in the control group, p = 0.041. In-hospital mortality was 34% in the hemoadsorption group versus 43% in the control group, p = 0.461. On ICU-admission and the first postoperative day, the cumulative vasopressor need was 0.17 versus 0.25 µg/kgBW/min, p = 0.123 and 0.06 versus 0.11 µg/kgBW/min, p = 0.037, and the systemic vascular resistance index was 1448 versus 941 dyn·s·cm-5, p = 0.013 and 1156 versus 858 dyn·s·cm-5, p = 0.110 in the hemoadsorption versus control group, respectively. Postoperative course of SOFA score normalized significantly (p = 0.01) faster in the hemoadsorption group. CONCLUSIONS: In high-risk cardiac surgical patients with infective endocarditis, intraoperative hemoadsorption significantly reduced sepsis-associated mortality. Furthermore, intraoperative hemoadsorption resulted in significant faster recovery of hemodynamics and organ function. Intraoperative hemoadsorption seems to attenuate the severity of postoperative sepsis.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Endocardite Bacteriana , Endocardite , Sepse , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/métodos , Endocardite/cirurgia , Endocardite Bacteriana/cirurgia , Humanos , Escores de Disfunção Orgânica , Complicações Pós-Operatórias , Estudos Retrospectivos , Sepse/etiologia , Sepse/terapia
19.
BMC Cardiovasc Disord ; 22(1): 338, 2022 07 29.
Artigo em Inglês | MEDLINE | ID: mdl-35906539

RESUMO

BACKGROUND: Valve surgery guidelines for infective endocarditis (IE) are unchanged over decades and nationwide data about the use of valve surgery do not exist. METHODS: We included patients with first-time IE (1999-2018) using Danish nationwide registries. Proportions of valve surgery were reported for calendar periods (1999-2003, 2004-2008, 2009-2013, 2014-2018). Comparing calendar periods in multivariable analyses, we computed likelihoods of valve surgery with logistic regression and rates of 30 day postoperative mortality with Cox regression. RESULTS: We included 8804 patients with first-time IE; 1981 (22.5%) underwent surgery during admission, decreasing by calendar periods (N = 360 [24.4%], N = 483 [24.0%], N = 553 [23.5%], N = 585 [19.7%], P = < 0.001 for trend). For patients undergoing valve surgery, median age increased from 59.7 to 66.9 years (P ≤ 0.001) and the proportion of males increased from 67.8% to 72.6% (P = 0.008) from 1999-2003 to 2014-2018. Compared with 1999-2003, associated likelihoods of valve surgery were: Odds ratio (OR) = 1.14 (95% CI: 0.96-1.35), OR = 1.20 (95% CI: 1.02-1.42), and OR = 1.10 (95% CI: 0.93-1.29) in 2004-2008, 2009-2013, and 2014-2018, respectively. 30 day postoperative mortalities were: 12.7%, 12.8%, 6.9%, and 9.7% by calendar periods. Compared with 1999-2003, associated mortality rates were: Hazard ratio (HR) = 0.96 (95% CI: 0.65-1.41), HR = 0.43 (95% CI: 0.28-0.67), and HR = 0.55 (95% CI 0.37-0.83) in 2004-2008, 2009-2013, and 2014-2018, respectively. CONCLUSIONS: On a nationwide scale, 22.5% of patients with IE underwent valve surgery. Patient characteristics changed considerably and use of valve surgery decreased over time. The adjusted likelihood of valve surgery was similar between calendar periods with a trend towards an increase while rates of 30 day postoperative mortality decreased.


Assuntos
Endocardite Bacteriana , Endocardite , Implante de Prótese de Valva Cardíaca , Idoso , Endocardite/diagnóstico , Endocardite/etiologia , Endocardite/cirurgia , Endocardite Bacteriana/cirurgia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Modelos de Riscos Proporcionais , Sistema de Registros
20.
J Cardiothorac Surg ; 17(1): 173, 2022 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-35804449

RESUMO

BACKGROUND: Papillary muscle rupture due to infective endocarditis is a rare event and proper management of this condition has not been described in the literature. Our case aims to shed light on treatment strategies for these patients using the current guidelines. CASE PRESENTATION: This case presents a 58-year-old male with acute heart failure secondary to papillary muscle rupture. He underwent an en bloc resection of his mitral valve with a bioprosthetic valve replacement. Specimen pathology later showed necrotic papillary muscle due to infective endocarditis. The patient was further treated with antibiotic therapy. He recovered well post-operatively and continued to do well after discharge. CONCLUSION: In patients who present with papillary muscle rupture secondary to infective endocarditis, clinical symptoms should drive the treatment strategy. Despite the etiology, early mitral valve surgery remains treatment of choice for patients who have papillary muscle rupture leading to acute heart failure. Culture-guided prolonged antibiotic treatment is vital in this category of patients, especially those who have a prosthetic valve implanted.


Assuntos
Endocardite Bacteriana , Endocardite , Insuficiência Cardíaca , Ruptura Cardíaca , Insuficiência da Valva Mitral , Doença Aguda , Endocardite/complicações , Endocardite Bacteriana/complicações , Endocardite Bacteriana/patologia , Endocardite Bacteriana/cirurgia , Insuficiência Cardíaca/complicações , Ruptura Cardíaca/complicações , Ruptura Cardíaca/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/diagnóstico , Insuficiência da Valva Mitral/etiologia , Insuficiência da Valva Mitral/cirurgia , Músculos Papilares/cirurgia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...