Optimal Timing for Cardiac Surgery in Infective Endocarditis: Is Earlier Better?
- First Online:
- 358 Downloads
All patients with infective endocarditis should be transferred to a hospital with cardiac surgery facilities. Once the decision to operate on a patient with infective endocarditis has been made, the timing of surgery is very often a difficult decision. Literature on this topic is very scarce. The European Society of Cardiology guidelines include recommendations on the timing of surgery. Heart failure, uncontrolled infection and prevention of embolic risk are the three main indications for surgery. Most often, when the decision to operate has been made, there is no benefit and potentially harm in delaying surgery. If cardiac surgery is indicated after an ischemic stroke, it should not be delayed. Discussion should be multidisciplinary and involve at least a cardiologist, a cardiac surgeon and an infectious diseases specialist, and any other specialist as needed (for example a neurologist).
KeywordsInfective endocarditis Surgery
Papers of particular interest, published recently, have been highlighted as: •• Of major importance
- 1.Murdoch DR, Corey GR, Hoen B, Miró JM, Fowler Jr VG, Bayer AS, et al. Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the International Collaboration on Endocarditis-Prospective Cohort Study. Arch Intern Med. 2009;169:463–73.PubMedCentralPubMedCrossRefGoogle Scholar
- 6.Habib G, Hoen B, Tornos P, Thuny F, Prendergast B, Vilacosta I, et al. Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009): the Task Force on the Prevention, Diagnosis, and Treatment of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and the International Society of Chemotherapy (ISC) for Infection and Cancer. Eur Heart J. 2009;30:2369–413.PubMedCrossRefGoogle Scholar
- 8.••Thuny F, Beurtheret S, Mancini J, Gariboldi V, Casalta JP, Riberi A, et al. The timing of surgery influences mortality and morbidity in adults with severe complicated infective endocarditis: a propensity analysis. Eur Heart J. 2011;32:2027–33. One of the very few studies on the influence of very early surgery on the prognosis of infective endocarditis.PubMedCrossRefGoogle Scholar
- 10.Sexton DJ, Spelman D. Current best practices and guidelines. Assessment and management of complications in infective endocarditis. Cardiol Clin. 2003;21:273–82, vii–viii.Google Scholar
- 13.Baddour LM, Wilson WR, Bayer AS, Fowler Jr VG, Bolger AF, Levison ME, et al. Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America. Circulation. 2005;111:e394–434.PubMedCrossRefGoogle Scholar
- 20.Snygg-Martin U, Gustafsson L, Rosengren L, Alsiö A, Ackerholm P, Andersson R, et al. Cerebrovascular complications in patients with left-sided infective endocarditis are common: a prospective study using magnetic resonance imaging and neurochemical brain damage markers. Clin Infect Dis. 2008;47:23–30.PubMedCrossRefGoogle Scholar
- 21.Cooper HA, Thompson EC, Laureno R, Fuisz A, Mark AS, Lin M, et al. Subclinical brain embolization in left-sided infective endocarditis: results from the evaluation by MRI of the brains of patients with left-sided intracardiac solid masses (EMBOLISM) pilot study. Circulation. 2009;120:585–91.PubMedCrossRefGoogle Scholar
- 26.Dickerman SA, Abrutyn E, Barsic B, Bouza E, Cecchi E, Moreno A, et al. The relationship between the initiation of antimicrobial therapy and the incidence of stroke in infective endocarditis: an analysis from the ICE Prospective Cohort Study (ICE-PCS). Am Heart J. 2007;154:1086–94.PubMedCrossRefGoogle Scholar
- 29.••Barsic B, Dickerman S, Krajinovic V, Pappas P, Altclas J, Carosi G, et al. Influence of the timing of cardiac surgery on the outcome of patients with infective endocarditis and stroke. Clin Infect Dis. 2013;56:209–17. A study showing that surgery in patients with infective endocarditis and stroke does not worsen prognosis. PubMedCrossRefGoogle Scholar