Infective endocarditis (IE) is a disease with severe complications and high mortality. It is heterogeneous in etiology, clinical manifestations, and course. At the same time, there are many disputes on the clinical practice of antibiotic treatment, surgical indications and timing. In this review, we discuss the epidemiology, diagnosis, treatment, and prevention of IE, especially the latest advances in surgical treatment after the release of European Society of Cardiology and American Heart Association guidelines in 2015.
ObjectiveTo discuss the key nursing points for patients with infective endocarditis and congenital isolated kidney after valve replacement. MethodsIn December 2012, one infective endocarditis patient with isolated kidney underwent heart valve replacement in our hospital. In addition to actively preventing postoperative infection of the heart valve, our nursing focused mainly on the isolated kidney protection and monitoring, and the related complications. ResultsThe surgery was successful, and the isolated kidney was effectively protected. The patient recovered and was discharged from the hospital. ConclusionFor patients with congenital isolated kidney with infective endocarditis, patients' urine output per hour and 24 h discrepancy quantity should be closely observed after valve replacement surgery. It is also very important to intervene early and carry out comprehensive protection of the renal function.
Intracranial hemorrhage (ICH) represents a severe complication of infective endocarditis (IE) and stands as a significant contributor to the poor prognosis associated with IE. Current guidelines suggested a delay of 4 weeks for cardiac surgery in patients with ICH, but these recommendations were based on insufficient clinical evidence, and recent studies have yielded different opinions. In this paper, we thoroughly reviewed relevant guidelines and their references in conjunction with 3 typical cases with IE and ICH, discussed the recommendations with controversy, and proposed a process for the management of IE with ICH.
ObjectiveTo systematically review the short term and long term efficacy of early surgery for infective endocarditis (IE) patients. MethodsWe searched PubMed, EMbase, The Cochrane Library, CBM, WanFang Data and CNKI databases for cohort studies concerning the efficacy of early surgery for IE patients from inception to October 2014. Two reviewers independently screened literature, extracted data and assessed the risk bias of included studies. Then meta-analysis was performed by using RevMan 5.3 software. ResultsSixteen cohort studies including 8 141 patients were included. The results of meta-analysis showed that early surgery could reduce the short term mortality (OR=0.57, 95%CI 0.42 to 0.77, P=0.000 4) and long term mortality (OR=0.57, 95%CI 0.43 to 0.77, P=0.000 7) in IE patients. Subgroup analysis showed that early surgery could significantly reduce the short term mortality and long term mortality in patients with native valve endocarditis (NVE). ConclusionEarly surgery can reduce IE patients' short term mortality and long term mortality. Due to the limited quality and quantity of the included studies, more large-scale high-quality studies are needed to verify the above conclusion.
Objective To investigate the knowledge level of Chinese cardiac surgeons regarding the management of infective endocarditis (IE), in order to identify the gap between clinical practices and the latest guidelines, and provide evidence-based support for improving the clinical management of IE. Methods A nationwide survey was conducted through an online questionnaire from December 5, 2024, to December 31, 2024. Descriptive analysis of the survey data was performed. Results A total of 67 valid responses were received from 18 provincial-level administrative divisions across China. While 56.7% (38/67) of respondents demonstrated familiarity with the modified Duke criteria, only 43.3% (29/67) comprehended the 2023 Duke- International Society of Cardiovascular Infectious Diseases criteria. Conversely, 43.3% (29/67) exhibited limited understanding of the former, and 56.7% (38/67) showed deficient knowledge of the latter diagnostic standards. Only 46.3% (31/67) reported proficiency in current IE management guidelines/consensus. Regarding surgical timing, 26.9% (18/67) advocated intervention within 7-14 days of antimicrobial therapy, 22.4% (15/67) during 14-28 days, and 10.5% (7/67) beyond 28 days. Notably, a significant proportion of respondents opted for delayed surgical intervention beyond guideline recommendations when managing patients with heart failure, uncontrolled infection, or neurological complications. Conclusion A knowledge gap and practice discrepancies exist among Chinese surgeons regarding the management of IE. There is an urgent need to promote updated concepts regarding surgical indications and timing for IE in order to optimize treatment strategies and improve patient prognosis.
ObjectiveTo compare the clinical outcomes of mitral valvuloplasty (MVP) and mitral valve replacement (MVR) for infective endocarditis, and to investigate the effect of MVP under different surgical risks. MethodsA retrospective study was done on the patients with mitral infective endocarditis, who underwent surgical treatment in our department from January 2018 to March 2022. According to the procedures, the patients were divided into a MVP group and a MVR group. Propensity score matching method was applied with a ratio of 1:1 to eliminate the biases. The early and midterm outcomes were compared between the two groups after matching. According to the European System for Cardiac Operative Risk Evaluation Ⅱ(EuroSCORE-Ⅱ), the effect of MVP was compared between high and low risk patients. ResultsA total of 195 patients were collected. There were 141 patients in the MVP group (120 males, 85.1%) and 54 patients in the MVR group (41 males, 75.9%). The mean follow-up time was (34.0±16.1) months. Patients in the MVP group were younger [(42.7±14.6) years vs. (56.8±13.0) years, P<0.001] and had better preoperative conditions. The patients in the MVP group had a shorter ICU stay [3.0 (2.0, 5.0) d vs. 4.0 (3.0, 8.0) d, P=0.004], and lower incidences of low cardiac output syndrome (0.7% vs. 9.3%, P=0.007), in-hospital mortality (0.0% vs. 3.7%, P=0.023), and follow-up mortality (4.3% vs. 15.4%, P=0.007). However, after 1:1 propensity score matching, there were no statistical differences in the baseline data or postoperative and follow-up adverse events between the two groups (P>0.05). Also, there was no statistical difference in the mortality of high-risk patients between MVP and MVR group (P>0.05). There was no statistical difference in the reoperation or recurrent severe mitral regurgitation between high and low-risk patients in the MVP group (P>0.05). Conclusion MVP is feasible for treating mitral lesions caused by infective endocarditis with good early and midterm outcomes. For patients with severer preoperative conditions, if the leaflet damage is not severe, MVP may be a viable option, but validation with larger sample sizes is needed.
ObjectiveTo study the relationship between the timing of surgery and one-year outcome in patients with infective endocarditis. MethodsWe retrospectively analyzed the clinical data of 97 patients suffered from leftside native valve infective endocarditis with neoplasm, admitted in Shanghai First People's Hospital between January 2000 and December 2011. There were 65 males and 32 females with mean age of 55.2±16.3 years (ranged 29 to 75 years). They were divided into two groups according to whether the surgery was performed within a week after diagnosis. The in-hospital mortality and one-year mortality, embolism and re-infection were calculated and compared between the two groups. ResultsThere was no significant difference in the in-hospital mortality between the early surgery group and the conventional surgery group (1.9% versus 6.7%, P=0.241). While there was a significant difference in the rate of inhospital embolism related complications (1.9% versus 13.3%, P=0.030) between the two groups. There was no significant difference in one-year mortality between the two groups (1.9% versus 8.9%, P=0.122). The incidence rate of embolism related complication was 5.8% in the early surgery group and 20.0% in the conventional surgery group with a statistical difference (P=0.034). There was one patient with recurrent cerebral infarction among the 11 patients of cerebral infarction in the early surgery group,while 6 recurrent patients in the 9 patients with cerebral infarction in the conventional surgery group (9.1% versus 66.7%, P<0.005). ConclusionsEarly surgery in patients with left-side native valve infective endocarditis can't reduce the in-hospital mortality and one-year mortality but does decrease embolic events significantly. Early surgery is feasible in the patients with cerebral infarction.
Abstract： Objective To summarize the clinical diagnostic and therapeutic experiences of infective endocarditis (IE). Methods From Jan. 2000 to Aug. 2006，60 IE patients underwent heart operation in PLA General Hospital. There were 46 male and 14 female patients, with an average age of 34.3 years old. Blood culture was positive in 25 cases (41.7%), Streptococcus was found in 12 cases, Staphylococcus in 6 cases and other bacteria in 7 cases. Ultrasonic cardiography(UCG) revealed vegetations or valve perforation in 42 cases, including 26 aortic valves, 9 mitral valves and 6 double valves. 28 cases had primary cardiac diseases，including 16 cases of congenital heart anomalies，9 cases of rheumatic heart disease and 3 cases of mitral valve prolapse. High dose of sensitive antibiotics were utilized all through the treatment in all IE patients. There were 55 selective surgeries and 5 emergent ones. Infected tissues were debrided radically，intracardiac malformation was corrected in 16 cases, valve replacement was performed in 41 cases, tricuspid plasty in 1 case. Results There were 3 patients of earlydeath. 51 patients(89.5%) were followedup for 5-71 months with norecurrence. Postoperative cardiac function (NYHA): class I was in 38 cases, class II in 13 cases. Conclusion Early diagnosis, optimal surgical timing, combined internal medicine and surgical treatment provided good therapeutic effect of IE.
ObjectiveTo investigate clinical outcomes of mitral valvuloplasty (MVP)for the treatment of infective endocarditis (IE)and mitral regurgitation (MR). MethodsFrom March 2002 to January 2012, 33 patients with IE and MR underwent MVP in Fu Wai Hospital. There were 23 male and 10 female patients with their age of 10-67 (35.7±17.8)years. Thirteen patients had previous cardiac anomalies. Preoperatively, there were 5 patients with mild MR, 15 patients with moderate MR and 13 patients with severe MR. There were 5 patients in New York Heart Association (NYHA)functional classⅠ, 23 patients in classⅡ, 4 patients in classⅢ and 1 patient in classⅣ. All the patients received MVP including 14 patients received MVP in active phase of IE. Concomitantly, 6 patients received aortic valve replacement, 5 patients received tricuspid valvuloplasty, 1 patient received coronary artery bypass grafting, 1 patient received resection of left atrial myxoma and 1 patient received repair of aortic sinus aneurysm. Surgical procedures included pericardial patch closure of leaflet perforation in 5 patients, leaflet excision and suturing in 17 patients, double-orifice method in 3 patients, chordae transfer and artificial chordae implantation in 5 patients, and annuloplastic ring implantation in 15 patients. ResultsOne patient died of acute myocardial infarction 7 days after the operation. All other 32 patients were successfully discharged. Echocardiography before discharge showed left ventricular end-diastolic diameter (LVEDD, 48.9±7.6 mm)and left atrial diameter (LAD, 31.7±7.4 mm)were significantly smaller than preoperative values (P=0.000). Thirty-two patients were followed up for 6-125 (73.0±38.6)months. There was no death, IE recurrence, bleeding or thromboembolism during follow-up. One patient received mitral valve replacement for mitral stenosis 3 years after discharge. There were 25 patients in NYHA func-tional classⅠ, 5 patients in classⅡand 2 patients in classⅢ. There were 4 patients with mild MR, 1 patient with moderate MR, and 26 patients had no MR. One patient had faster mitral inflow at diastolic phase (1.7 m/s). One patient had moderate aortic regurgitation. LVEDD and LAD during follow-up were not statistically different from those before discharge. Left ventricular ejection fraction during follow-up was significantly higher than that before discharge (60.9%±6.6% vs. 57.5%±6.7%, P=0.043). ConclusionMVP is a reliable surgical procedure for patients with IE and MR, and can significantly reduce left atrial and left ventricular diameter and improve cardiac function postoperatively.
The patient underwent prostatectomy before two months. After the operation, he suffered from intermittent fever, chest tightness, and suffocation. Combined with the history, symptoms, signs, laboratory examination, echocardiography, imaging examination (CT), and the positive blood culture for Enterococcus faecalis, the admitting diagnosis was aortic stenosis and insufficiency, mitral insufficiency, cardiac function grade Ⅲ (New York Heart Association grade), infective endocarditis, and aneurysm of aortic sinus. After 4-week antimicrobial drug treatment, the patient was in a stable condition with normal body temperature, multiple negative blood cultures, and normal laboratory-related examinations. After careful and sufficient preparation, transcatheter aortic valve replacement operation was performed in the hybrid operating room with 32 mm Venus-A valve. The operation was successful and the patient was discharged on the seventh day after operation. He continued to be treated with antimicrobial drugs for 4 weeks after surgery, and his temperature was normal. He had no chest tightness, asthma, or other symptoms. One, three, and six months after operation, blood tests and erythrocyte sedimentation rate were normal, electrocardiogram showed sinus rhythm, and echocardiography showed a maximum aortic valve pressure difference of 7 mm Hg (1 mm Hg=0.133 kPa), no perivalvular leak and no pericardial effusion.