PMID- 19444403
OWN - NLM
STAT- MEDLINE
DCOM- 20090805
LR  - 20221207
IS  - 1615-6692 (Electronic)
IS  - 0340-9937 (Linking)
VI  - 34
IP  - 3
DP  - 2009 May
TI  - [Infective endocarditis: considerations regarding optimal timing for surgical 
      treatment].
PG  - 198-205
LID - 10.1007/s00059-009-3232-7 [doi]
AB  - BACKGROUND: Treatment of infective endocarditis is primarily conservative. 
      Persistent infection, tissue destruction und hemodynamic instabilities argue - in 
      dependence on the microorganisms involved - for an urgent surgical treatment, 
      even when there is still no control of the local and systemic infection. For 
      timing of the surgical intervention, the following suggestions seem to be valid: 
      TIMING OF THE SURGICAL INTERVENTION: Delayed surgical indication is considered a 
      prognostic factor of extraordinary relevance for surgical treatment of infective 
      endocarditis. Presence of intramyocardial, paravalvular and root abscess or 
      development of a septic cardiomyopathy (in addition to the valve-related 
      disturbed pump and muscular function), systemic sepsis and irreversible 
      extracardiac organ destruction (liver, spleen, kidney, brain, lung, bone, etc.) 
      reduce the surgical prognosis even after successful and complete surgical 
      treatment. Extracardiac foci may determine the postoperative course. After 
      cerebral embolization the cardiac operation should be performed as early as 
      possible (within 24-48 h after embolization). Extreme extent of cardiac and 
      extracardiac tissue destruction due to delayed surgical indication can result in 
      a situation, where adequate surgical treatment of the local focus is not likely 
      to be successful anymore and prognosis becomes infaust. In their own patients, 
      the authors observed: NYHA (New York Heart Association) III-IV > 50%; renal 
      failure (dialysis) > 15%, systemic embolization > 30%, cerebral embolization > 
      8%, cardiogenic shock > 10%. SURGICAL TREATMENT: The most important aspect is 
      complete debridement of all infected tissue with a safety margin of about 3 mm. 
      This holds true, even if it results in resection of the entire aortic root, 
      mitral ring, aortic wall, and atrial tissue. There is no contraindication to the 
      implantation of prosthetic materials (valves, bovine pericardium, mitral rings) 
      as long as surgical debridement has been prompt and aggressive. Not the type of 
      prosthesis, but the quality of surgical debridement is of prognostic relevance. 
      Reconstructive techniques are suggested whenever possible and are primarily 
      effective for the treatment of mitral and tricuspid valves. Prompt and aggressive 
      eradication of extracardiac foci is important to the patient's postoperative 
      course. POSTOPERATIVE COURSE AND TIMING OF THE OPERATION: After successful 
      surgical treatment of the intracardiac focus, the postoperative course is mainly 
      determined by extracardiac foci, systemic sepsis, and persistent secondary organ 
      destruction. PERSPECTIVE: As the results of conservative treatment of infective 
      endocarditis are still not satisfactory, in some subgroups improved surgical 
      results due to aggressive and radical debridement of infective tissue (with a 
      safety margin of at least 3 mm) will suggest the surgical treatment option even 
      in those patients, that have primarily been considered for conservative 
      treatment.
FAU - Denk, Katja
AU  - Denk K
AD  - Klinik fur Herz-, Thorax-undGefasschirurgie, Universitatsmedizin, Mainz.
FAU - Vahl, Christian-Friedrich
AU  - Vahl CF
LA  - ger
PT  - English Abstract
PT  - Journal Article
PT  - Review
TT  - Endokarditis: Entscheidungshilfen fur den optimalen Zeitpunkt zur operativen 
      Sanierung.
PL  - Germany
TA  - Herz
JT  - Herz
JID - 7801231
SB  - IM
MH  - Cardiovascular Surgical Procedures/*methods
MH  - Debridement/*methods
MH  - Endocarditis/*diagnosis/*surgery
MH  - Humans
MH  - Plastic Surgery Procedures/*methods
RF  - 20
EDAT- 2009/05/16 09:00
MHDA- 2009/08/06 09:00
CRDT- 2009/05/16 09:00
PHST- 2009/05/16 09:00 [entrez]
PHST- 2009/05/16 09:00 [pubmed]
PHST- 2009/08/06 09:00 [medline]
AID - 10.1007/s00059-009-3232-7 [doi]
PST - ppublish
SO  - Herz. 2009 May;34(3):198-205. doi: 10.1007/s00059-009-3232-7.