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1.
Kyobu Geka ; 73(1): 4-8, 2020 Jan.
Artigo em Japonês | MEDLINE | ID: mdl-31956243

RESUMO

According to the current guideline, early surgery is recommended in patients with infective endocarditis (IE). On the other hand, mitral valve plasty (MVP) became the preferred surgical option in patients with IE, because of its benefits in the preservation of left ventricular function and prevention of recurrence of infection. Feasibility of MVP is an important issue in surgical strategy, however, it might be associated with the timing of the operation:feasibility of MVP might be higher in healed IE than active IE, although there had been no clear evidence in previous studies. In order to develop scoring system to predict feasibility of MVP in patients with active IE, we have introduced "severity score".Severity score defined as the sum of valvular score which evaluates the extensiveness of the valvular destruction, and technical score which evaluates the complexity and durability of the repair. Probability of feasible MVP was high in severity score≤7 points and low in severity score≥9 points. MVP is basically selected in patients with severity score of 8 points, taking the benefit of patients and risks of longterm durability into consideration. We believe that severity score is valuable and reproducible scoring system in surgical decision making.


Assuntos
Endocardite Bacteriana , Insuficiência da Valva Mitral , Prolapso da Valva Mitral , Endocardite Bacteriana/cirurgia , Humanos , Valva Mitral
3.
Braz J Cardiovasc Surg ; 34(5): 615-617, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31719013

RESUMO

We report a case of a 59-year-old female patient with vegetative native mitral valve endocarditis caused by Stenotrophomonas maltophilia (SM). She had hemodialysis-dependent chronic renal failure, but no immunosuppressive disease. Echocardiography showed mobile vegetation on her native mitral valve. Right femoral artery embolectomy and mitral valve replacement were performed simultaneously. She awakened from anesthesia, but she passed away due to septic shock complications. To the best of our knowledge, this was the first case in whom native mitral valve endocarditis caused by SM was observed (despite of absence of any immunosuppressive event) and needed to undergo valve replacement.


Assuntos
Endocardite Bacteriana/cirurgia , Infecções por Bactérias Gram-Negativas/cirurgia , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Valva Mitral/cirurgia , Stenotrophomonas maltophilia , Endocardite Bacteriana/complicações , Endocardite Bacteriana/microbiologia , Evolução Fatal , Feminino , Infecções por Bactérias Gram-Negativas/complicações , Doenças das Valvas Cardíacas/complicações , Doenças das Valvas Cardíacas/microbiologia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Humanos , Pessoa de Meia-Idade , Choque Séptico/etiologia
7.
Kardiol Pol ; 77(5): 561-567, 2019 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-31066721

RESUMO

BACKGROUND: The rate of cardiac device-related infective endocarditis (CDRIE) is increasing worldwide, but no detailed data are available for Poland. AIMS: We aimed to evaluate clinical, diagnostic, and therapeutic data of patients hospitalized due to CDRIE in 22 Polish referential cardiology centers from May 1, 2016 to May 1, 2017. METHODS: Participating cardiology departments were asked to fill in a questionnaire that included data on the number of hospitalized patients, number and types of implanted cardiac electrotherapy devices, and number of infective endocarditis cases. We also collected clinical data and data regarding the management of patients with CDRIE. RESULTS: Overall, 99 621 hospitalizations were reported. Infective endocarditis unrelated to cardiac device was the cause of 596 admissions (0.6%), and CDRIE, of 195 (0.2%). Pacemaker was implanted in 91 patients with CDRIE (47%); cardioverter­defibrillator, in 51 (26%); cardiac resynchronization therapy­defibrillator, in 48 (25%); and cardiac resynchronization therapy­pacemaker, in 5 (2.5%). The most common symptoms were malaise (62%), fever/chills (61%), cough (21%), chest pain (19.5%), and inflammation of the device pocket (5.6%). Cultures were positive in 77.5% of patients. The cardiac device was removed in 91% of patients. The percutaneous approach was most common for cardiac device removal. All patients received antibiotic therapy, and 3 patients underwent a heart valve procedure. Transesophageal echocardiography was performed in 80% of patients. The most common complication was heart failure (25% of patients). CONCLUSIONS: The clinical profile, pathogen types, and management strategies in Polish patients with CDRIE are consistent with similar data from other European countries. Transesophageal echocardiography was performed less frequently than recommended. The removal rate in the Polish population is consistent with the general rates observed for interventional treatment in patients with CDRIE.


Assuntos
Desfibriladores Implantáveis/efeitos adversos , Remoção de Dispositivo/estatística & dados numéricos , Endocardite/etiologia , Marca-Passo Artificial/efeitos adversos , Sistema de Registros , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Serviço Hospitalar de Cardiologia , Desfibriladores Implantáveis/estatística & dados numéricos , Ecocardiografia Transesofagiana/estatística & dados numéricos , Endocardite/diagnóstico por imagem , Endocardite/epidemiologia , Endocardite/cirurgia , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/epidemiologia , Endocardite Bacteriana/etiologia , Endocardite Bacteriana/cirurgia , Feminino , Insuficiência Cardíaca/etiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Marca-Passo Artificial/estatística & dados numéricos , Polônia/epidemiologia , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/epidemiologia , Infecções Relacionadas à Prótese/cirurgia
8.
Intern Med ; 58(16): 2323-2331, 2019 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-31118367

RESUMO

Objective Embolic events are frequent and life-threatening complications of infective endocarditis (IE). Recently, an embolic risk assessment at admission, based on the Embolic Risk (ER) French Calculator, was designed to predict the development of symptomatic emboli associated with IE. This study aimed to validate the ER French Calculator for the prediction of in-hospital events, including embolic events. Methods We retrospectively analyzed the clinical features of 52 consecutive patients with left-sided IE to identify possible predictors of in-hospital events within 30 days of admission. Results New embolic events were seen in 15 patients (29%), cardiac surgery was performed in 22 patients (42%), and 1 patient (2%) died within 30 days of admission. A composite endpoint of embolic complications, cardiac surgery, or death was observed in 28 patients (54%). The cumulative incidence of new embolic events was significantly higher in the high-risk group identified by the ER French Calculator than in the low-risk group (log-rank test; p=0.0004). The incidence of the composite endpoint was higher in the high-risk group than in the low-risk group (log-rank test; p<0.0001). A multivariate Cox proportional hazards model indicated that the high-risk designation on the ER French Calculator predicted embolic events (p=0.0410) and composite events (p=0.0371) independently of other candidate predictors. Conclusion The ER French Calculator may be a useful tool for predicting new in-hospital embolic events and other unfavorable in-hospital events in patients with IE.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Embolia/etiologia , Embolia/terapia , Endocardite Bacteriana/complicações , Endocardite Bacteriana/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Incidência , Japão , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Medição de Risco , Fatores de Risco
9.
BMJ Case Rep ; 12(4)2019 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-30975780

RESUMO

A 40-year-old woman presented with postoperative fever. Echocardiography revealed a large pedunculated cauliflower right atrial mass of heterogeneous echogenicity attached to the eustachian valve measuring about 2×3 cm. She underwent surgical excision, gross and microscopical examination were consistent with eustachian valve infective endocarditis.


Assuntos
Endocardite Bacteriana/diagnóstico , Valvas Cardíacas , Histerectomia/efeitos adversos , Infecções Estafilocócicas/diagnóstico , Staphylococcus aureus/isolamento & purificação , Adulto , Diagnóstico Diferencial , Ecocardiografia , Endocardite Bacteriana/diagnóstico por imagem , Endocardite Bacteriana/cirurgia , Feminino , Febre/etiologia , Humanos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/cirurgia , Infecções Estafilocócicas/diagnóstico por imagem , Infecções Estafilocócicas/cirurgia
10.
J Interv Card Electrophysiol ; 55(2): 129-135, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31025152

RESUMO

PURPOSE: To perform a systematic review of reports in which the AngioVac™ percutaneous vacuum-assisted aspiration system was successfully used to debulk or remove vegetations prior to percutaneous lead extraction. METHODS: We included all studies and case reports that used a percutaneous aspiration technique for vegetation removal or debulking with percutaneous lead extraction for patients with lead-associated endocarditis. Ten reports and retrospective data from our centers were used, which included a total of 88 patients and 205 leads. RESULTS: The percutaneous aspiration procedure was completely or partially successful in 86 patients (97.7%). The lead extraction procedure itself was successful in 87 patients (98.9%). The aspiration procedure and lead extraction were done concomitantly in 81 patients (92.0%). Four patients (4.5%) had major complications (two due to vascular injuries, one due to coronary sinus injury, and one due to tricuspid valve injury). There were no complications from the aspiration procedure, and no cases were associated with procedure-related mortality. CONCLUSION: While patients with large vegetations have historically been referred for surgical lead extraction, data are lacking in its techniques and outcomes. Existing data suggest that percutaneous vacuum-assisted aspiration for vegetation removal or debulking in endocarditis prior to or concurrent with percutaneous lead extraction has a high success rate with a low complication rate across a broad series of patients.


Assuntos
Remoção de Dispositivo/instrumentação , Eletrodos Implantados , Endocardite Bacteriana/cirurgia , Marca-Passo Artificial , Infecções Relacionadas à Prótese/cirurgia , Vácuo , Humanos
12.
J Card Surg ; 34(6): 514-517, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30981216

RESUMO

Infective endocarditis following a Mitraclip procedure might be an under-recognized complication. We describe the case of infective endocarditis by Bartonella henselae as a late complication in a patient with a previously implanted MitraClip system for mitral valve repair. Due to the severity of infection, surgical treatment was performed despite the high preoperative surgical risk, but recurrence of endocarditis of the biological valve implanted occurred. Although infection with Bartonella is known as a possible source of endocarditis, it has never been described before in relation to failed MitraClip therapy.


Assuntos
Cateterismo Cardíaco/métodos , Doença da Arranhadura de Gato/cirurgia , Endocardite Bacteriana/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Próteses Valvulares Cardíacas/efeitos adversos , Insuficiência da Valva Mitral/cirurgia , Complicações Pós-Operatórias/cirurgia , Idoso , Feminino , Próteses Valvulares Cardíacas/microbiologia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Humanos , Recidiva , Índice de Gravidade de Doença , Falha de Tratamento
13.
R I Med J (2013) ; 102(3): 38-41, 2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-30943671

RESUMO

A 59-year-old man presented with sharp chest pain, hypoxia, and tachycardia. His past medical history included intravenous drug use (IVDU). Pseudomonas aeruginosa was isolated from his blood. Pseudomonas aeruginosa is a rare cause of endocarditis. Patient revealed that he injected drugs intravenously with tap water. Transesophageal echocardiogram revealed vegetation on the anterior mitral leaflet with associated mitral regurgitation. Patient was successfully treated with meropenem and tobramycin and underwent mitral valve replacement without complications. Majority of IVDU-related endocarditis caused by Pseudomonas involve right-sided valves, but our case is unique as it demonstrates left-sided endocarditis in a patient with IVDU. A combination of aggressive medical and early surgical treatment with valve replacement has enabled this patient to successfully recuperate.


Assuntos
Endocardite Bacteriana/diagnóstico , Infecções por Pseudomonas/diagnóstico , Pseudomonas aeruginosa/isolamento & purificação , Antibacterianos/uso terapêutico , Ecocardiografia Transesofagiana , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/cirurgia , Próteses Valvulares Cardíacas , Humanos , Masculino , Pessoa de Meia-Idade , Infecções por Pseudomonas/tratamento farmacológico , Abuso de Substâncias por Via Intravenosa/complicações
14.
J Card Surg ; 34(4): 170-180, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30843269

RESUMO

BACKGROUND: AngioVac is a new device for filtering intravascular thrombi and emboli. Publications on the device are limited and underpowered to objectively estimate its safety and efficacy. We aimed to overcome this by performing a meta-analysis on the results of AngioVac for treating venous thromboses and endocardial vegetations. METHODS: A systematic literature review was performed to identify all articles reporting cardiac vegetation and/or thrombosis extraction using AngioVac. Endpoints were successful removal, operative mortality, conversion to open surgery, hospital stay, recurrent thromboembolism, and follow-up mortality. Random effect model was used, and pooled event rates (PERs) and incidence rate (IR) were calculated. RESULTS: A total of 42 studies with 182 patients (81 vegetation and 101 thrombosis) were included. Overall mean follow-up times were 3.1 and 0.7 years in vegetation and thrombosis patients, respectively. The PERs for successful removal were 74.5 (confidence interval [CI]: 48.2-90.2), 80.5 (CI: 70.0-88.0), and 32.4 (CI: 17.0-52.8) in vegetation, right atrial/caval venous thrombi, and pulmonary emboli (PE) patients, respectively. The PERs for operative mortalities were 14.6 (CI: 7.7-25.8), 14.8 (CI: 8.5-24.5), and 32.3 (CI: 15.1-56.3), respectively. The PERs for conversion to open surgery were 25.0 (CI: 9.3-51.9) and 12.3 (CI: 5.4-25.6) in vegetation and thrombosis patients, respectively. The IR of recurrent thromboembolism was 0.18 per person per year (PPY) (CI: 0.00-14.69) in vegetation and 0.19 PPY (CI: 0.08-0.48) in thrombosis patients. IR of follow-up mortality was 0.37 PPY (CI: 0.11-1.21) in thrombosis patients. CONCLUSIONS: AngioVac is a viable option for extracting right-sided vegetations and right atrial/caval venous thrombi. Rates of successful extraction and mortality are significantly worse for PE.


Assuntos
Dispositivos de Proteção Embólica , Endocardite Bacteriana/cirurgia , Embolia Pulmonar/cirurgia , Trombectomia/instrumentação , Trombose Venosa/cirurgia , Bases de Dados Bibliográficas , Endocardite Bacteriana/mortalidade , Seguimentos , Humanos , Embolia Pulmonar/mortalidade , Trombectomia/métodos , Resultado do Tratamento , Trombose Venosa/mortalidade
16.
Ann Thorac Surg ; 108(3): e185-e187, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30771326

RESUMO

A 2-year-old boy underwent repeat right ventricular outflow tract reconstruction (re-RVOTR) with a bovine jugular vein (BJV) graft. He presented with high fever on postoperative day 6. Blood and drainage effusion cultures were all positive for Staphylococcus lugdunensis and vancomycin was prescribed. Echocardiography showed vegetation at the BJV. Re-re-RVOTR was performed 51 days after re-RVOTR. In the operation, vegetation was adhered to the right-sided leaflet and three leaflets were degenerated. After complete BJV graft resection, an expanded polytetrafluoroethylene conduit with trileaflets was implanted. There was no sign of recurrent infection 8 months after the surgery.


Assuntos
Endocardite Bacteriana/cirurgia , Veias Jugulares/transplante , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Staphylococcus lugdunensis/isolamento & purificação , Obstrução do Fluxo Ventricular Externo/cirurgia , Animais , Bioprótese , Procedimentos Cirúrgicos Cardíacos/métodos , Bovinos , Pré-Escolar , Ecocardiografia/métodos , Endocardite Bacteriana/diagnóstico por imagem , Humanos , Masculino , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/cirurgia , Prognóstico , Procedimentos Cirúrgicos Reconstrutivos/métodos , Reoperação/métodos , Infecções Estafilocócicas/diagnóstico por imagem , Infecções Estafilocócicas/cirurgia , Resultado do Tratamento , Obstrução do Fluxo Ventricular Externo/diagnóstico por imagem
17.
J Cardiothorac Surg ; 14(1): 41, 2019 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-30808391

RESUMO

BACKGROUND: Only 4.1% of tricuspid valve IE cases require surgical intervention. The complication after tricuspid valve IE with lung abscess and empyema is rare. CASE PRESENTATION: We report the case of a 38-year-old male (an intravenous drug abuser) diagnosed with tricuspid valve IE who underwent tricuspid valve replacement. The case was complicated by multiple lung abscesses and thoracic empyema. The pathogens causing the lung abscesses and empyema were Acinetobacter baumannii complex and Candida albicans, which were different from those causing the endocarditis. After 4 weeks of antibiotic treatment, chest X-ray revealed bilateral clear lung markings with only mild blunting of the right costophrenic angle. CONCLUSION: The pathogen causing the lung abscess is not always compatible with that causing the endocarditis. Thoracoscopic incision of the abscess with 4 to 6 weeks of broad-spectrum antibiotic treatment is effective and safe.


Assuntos
Empiema Pleural/microbiologia , Endocardite Bacteriana/microbiologia , Abscesso Pulmonar/microbiologia , Abuso de Substâncias por Via Intravenosa/microbiologia , Valva Tricúspide/cirurgia , Infecções por Acinetobacter/tratamento farmacológico , Infecções por Acinetobacter/microbiologia , Infecções por Acinetobacter/cirurgia , Acinetobacter baumannii/isolamento & purificação , Adulto , Antibacterianos/uso terapêutico , Candida albicans/isolamento & purificação , Candidíase/tratamento farmacológico , Candidíase/microbiologia , Candidíase/cirurgia , Empiema Pleural/tratamento farmacológico , Empiema Pleural/etiologia , Empiema Pleural/cirurgia , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/cirurgia , Implante de Prótese de Valva Cardíaca , Humanos , Abscesso Pulmonar/tratamento farmacológico , Abscesso Pulmonar/etiologia , Abscesso Pulmonar/cirurgia , Masculino , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/cirurgia , Staphylococcus aureus/isolamento & purificação , Abuso de Substâncias por Via Intravenosa/complicações , Toracoscopia , Valva Tricúspide/microbiologia
18.
Asian Cardiovasc Thorac Ann ; 27(4): 265-270, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30791694

RESUMO

BACKGROUND: Pulmonary valve replacement is one of the most common procedures in patients with congenital heart disease. Little is known about prosthetic valve endocarditis in this population. OBJECTIVES: To review management and outcomes of pediatric and adult patients with a prosthetic pulmonary valve or right ventricle-to-pulmonary artery conduit infective endocarditis. METHODS AND RESULTS: A multiinstitutional cohort of 10 patients is reported. Median age at endocarditis was 24 years (range 8-41 years). The most common causative organisms were Staphylococcus ( n = 4) and Streptococcus species ( n = 2). In addition to medical treatment, 5 patients required surgery. Majors complications such as renal damage, life-threatening hemoptysis, and septic shock were observed. No patient died in hospital or during follow-up. CONCLUSIONS: Pulmonary prosthetic valve endocarditis is a rare condition associated with significant morbidity and a high risk of requiring operative intervention. Larger studies are required to optimize the management.


Assuntos
Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Prótese Vascular/efeitos adversos , Endocardite Bacteriana/microbiologia , Cardiopatias Congênitas/cirurgia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/instrumentação , Próteses Valvulares Cardíacas/efeitos adversos , Infecções Relacionadas à Prótese/microbiologia , Valva Pulmonar/cirurgia , Adolescente , Adulto , Criança , Angiografia por Tomografia Computadorizada , Ecocardiografia Doppler em Cores , Ecocardiografia Transesofagiana , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/cirurgia , Feminino , Humanos , Masculino , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/cirurgia , Valva Pulmonar/diagnóstico por imagem , Reoperação , Estudos Retrospectivos , Fatores de Risco , Espanha , Resultado do Tratamento
19.
Am Heart J ; 210: 108-116, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30802708

RESUMO

BACKGROUND: In patients with active infective endocarditis (IE), the relationship between timing of surgery and survival is uncertain. The objective was to evaluate clinical characteristics associated with timing of surgery and the association between surgical timing and 6-month survival in complicated, left-sided IE. METHODS: In a prospective, multicenter, observational registry (The International Collaboration on Endocarditis-PLUS, registry from 2008 to 2012), clinical factors associated with timing of surgery during the index hospitalization were determined among 485 adult patients with definite, complicated, left-sided IE who underwent cardiac surgery during their index hospitalization. The relationship between early surgical intervention (<7 days from admission to surgery center) and outcome after surgery was analyzed. The primary end point of the study was 6-month survival. RESULTS: The median time to surgery from admission to surgical center was 7 (interquartile range 2-15) days. Patients who underwent earlier surgery were more likely transferred to the surgical center (74.2% vs 46.4%, P < .001) and had a lower percentage of preexisting heart failure (before IE diagnosis) (6.0% vs 17.3%, P < .001) but higher rate of acute heart failure (53.2% vs 38.4%, P = .001). Variables independently associated with surgery <7 days from admission were patient transfer, acute heart failure, and nonelective surgical status (C-index = 0.84), but predicted operative risk was not. Cox proportional hazards modeling with inverse probability of treatment weighting found that earlier surgery was associated with a trend toward higher 6-month mortality compared with later surgery (hazard ratio = 1.68, 95% CI 0.97-2.96; P = .065), particularly surgery within 2 days of admission or transfer. Mortality was significantly associated with operative risk and complicated IE, including Staphylococcus aureus infection and presence of abscess. CONCLUSIONS: Earlier surgery in IE is strongly associated with acute heart failure and surgical urgency. After adjustment for operative risk and IE complications, earlier surgery <7 days from admission was associated with a trend toward higher 6-month overall mortality compared with surgery later in the index hospitalization.


Assuntos
Endocardite Bacteriana/mortalidade , Endocardite Bacteriana/cirurgia , Tempo para o Tratamento , Abscesso/mortalidade , Doença Aguda , Adulto , Idoso , Endocardite Bacteriana/patologia , Feminino , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/etiologia , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Transferência de Pacientes/estatística & dados numéricos , Pontuação de Propensão , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de Risco , Infecções Estafilocócicas/mortalidade , Staphylococcus aureus , Procedimentos Cirúrgicos Operatórios
20.
Int J Artif Organs ; 42(4): 194-200, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30803290

RESUMO

Infective endocarditis is caused by a bacterial infection of the endocardial surface, and despite improvements in surgical interventions and antimicrobial therapy, mortality remains high. Recently published data suggest that intraoperative hemoadsorption therapy might represent a promising treatment option; however, randomized data still lack, and a comparative study on the intraoperative versus intraoperative plus postoperative use of CytoSorb has not yet been performed. We hypothesized that patients developing intraoperative renal failure benefit from additional postoperative CytoSorb treatment in terms of outcome. We examined the application of hemoadsorption therapy in 20 endocarditis patients separated into two groups: (1) sole intraoperative versus (2) intraoperative plus postoperative treatment, with regard to inflammatory and hemodynamic status, the postoperative course including development of complications, extent of extracorporeal organ support, and outcome. Despite an obviously more pronounced disease severity in the intraoperative plus postoperatively treated patients as evidenced by a higher initial European System for Cardiac Operative Risk Evaluation score, higher reoperation rate, longer cardiopulmonary bypass times, a worse inflammatory status, and perioperative development of acute renal failure, we observed a clear and comparable stabilization in hemodynamics and inflammatory parameters in both groups. More importantly and despite a higher rate of postoperative complications and a longer intensive care unit stay, patients from the intraoperative plus postoperative group showed an equal intensive care unit and 90-day survival compared to patients treated only intraoperatively. Our data suggest that postoperative continuation of hemoadsorption treatment might be beneficial in patients with endocarditis who develop perioperative renal failure in combination with severe hemodynamic instability and high-grade intraoperative findings.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Endocardite Bacteriana/terapia , Hemofiltração/métodos , Cuidados Intraoperatórios/métodos , Cuidados Pós-Operatórios/métodos , Complicações Pós-Operatórias , Idoso , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/métodos , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/fisiopatologia , Endocardite Bacteriana/cirurgia , Feminino , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Índice de Gravidade de Doença , Resultado do Tratamento
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