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Early surgery with aggressive surgical approach to improve 6-month outcomes in patients with active infective endocarditis: contribution of cerebral preoperative magnetic resonance imaging

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Abstract

Objectives

We investigated the hypothesis that early surgery for infective endocarditis (IE) attenuates the rate of death or embolic events and does not increase the rate of relapse or postoperative valvular dysfunction (PVD) at 6 months.

Methods

21 consecutive patients who underwent surgical treatment of IE were prospectively included. We assessed 6-month postoperative clinical outcomes by comparing early surgery (Group E, surgery within 72 h) and conventional treatment (Group C). Nine patients (43%) were assigned to Group E based on a combination of preoperative evaluation parameters, including the findings of cerebral magnetic resonance imaging (MRI), which was performed in all patients with left-sided IE.

Results

Six surgical plans (5 advancements and 1 postponement) were modified by routine MRI. Although preoperative echocardiography did not confirm all annular invasions, the rate of periannular infection, which was treated by pericardial annular patch plasty (56%) in patients with native-valve IE, was higher in Group E than C (P = 0.006). Early surgery based on MRI findings resulted in no postoperative embolic events or cerebral bleeding. The 6-month mortality rate was 0% in both groups, although the calculated 6-month IE mortality rate was 49.2 ± 25% and 28.8 ± 18%, respectively. No recurrence of IE or PVD occurred in Group E. The 6-month rate of freedom from composite events was 100% in Group E.

Conclusions

Aggressive treatment (periannular resection and disuse of a prosthetic annuloplasty ring) and optimal antibiotic therapy based on intraoperative microorganisms, even in patients who underwent early surgery, reduced the 6-month relapse and PVD rates.

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Acknowledgements

We thank Angela Morben, DVM, ELS, from Edanz Group (http://www.edanzediting.com/ac), for editing a draft of this manuscript. We also thank Terae Satoshi, a radiologist in Sapporo City General Hospital, for providing advice regarding the MRI findings.

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Authors and Affiliations

  1. Department of Cardiovascular Surgery, Sapporo City General Hospital, North 11 West 13 Chuo-ku, Sapporo, Hokkaido, 060-8604, Japan

    Masanori Nakamura, Takeshi Uzuka, Hiroshi Sato, Mayo Kondo & Junichi Sakata

  2. Departments of Infection Control, Sapporo City General Hospital, Sapporo, Japan

    Fumihiro Kodama

  3. Departments of Cardiology, Sapporo City General Hospital, Sapporo, Japan

    Daisuke Murai, Hiroshi Komatsu, Takao Makino & Tetsuro Kohya

Authors
  1. Masanori Nakamura
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  2. Takeshi Uzuka
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  3. Hiroshi Sato
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  4. Mayo Kondo
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  5. Junichi Sakata
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  6. Fumihiro Kodama
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  7. Daisuke Murai
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  8. Hiroshi Komatsu
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  9. Takao Makino
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  10. Tetsuro Kohya
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Correspondence to Masanori Nakamura.

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Nakamura, M., Uzuka, T., Sato, H. et al. Early surgery with aggressive surgical approach to improve 6-month outcomes in patients with active infective endocarditis: contribution of cerebral preoperative magnetic resonance imaging. Gen Thorac Cardiovasc Surg 67, 427–435 (2019). https://doi.org/10.1007/s11748-018-1040-9

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  • DOI: https://doi.org/10.1007/s11748-018-1040-9

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