Document Detail


Surgical treatment of prosthetic valve endocarditis in patients with double prostheses: is single-valve replacement safe?
MedLine Citation:
PMID:  19640728     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Bias against operating on patients with prosthetic valve endocarditis (PVE) who have multiple prostheses may preclude the use of life-saving valve replacement. We investigated the accuracy of the preoperative diagnosis of PVE in patients with both mitral and aortic prosthesis and the safety of single-valve replacement when only one valve seemed infected.
METHODS: Patients with a diagnosis of active PVE who had mitral and aortic prosthesis in place were assessed. We looked at the methods for diagnosis, causative agents, indication for valve replacement, operative findings and outcome.
RESULTS: Twenty patients, who had both mitral and aortic prostheses and a diagnosis of PVE, were assessed. Streptococci and staphylococci caused 70% of cases. By means of echocardiography, the valves involved were: mitral (11 patients), aortic (six patients), and in three cases both prosthetic valves seemed infected. Surgery was undertaken in 17 patients (85%). The positive predictive value of transesophageal echocardiogram (TEE) for the preoperative diagnosis of the site of infection was 100%. In 13 patients, only the prosthetic valve that seemed infected was replaced. Four of these patients died within a week after the procedure. Nine patients survived the surgical procedure, completed a course of antimicrobial therapy and were followed up for 15.78 months (95% CI: 12.83-18.72). All were considered cured and relapses were not observed.
CONCLUSIONS: TEE allowed a diagnosis of site involvement that did correlate with the anatomic diagnosis obtained during the operation. This fact contributed to the management of patients and was of great help in guiding the surgical intervention. Echo-oriented single-valve replacement may be a safe strategy for patients with PVE and double prostheses.
Authors:
Manuel L Fernández Guerrero; Julio Alonso; Manuel Rey; Jorge Martinell; Miguel Górgolas; Victor Artiz; Julian Fraile
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Publication Detail:
Type:  Evaluation Studies; Journal Article     Date:  2009-07-28
Journal Detail:
Title:  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery     Volume:  37     ISSN:  1873-734X     ISO Abbreviation:  Eur J Cardiothorac Surg     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2010-02-03     Completed Date:  2011-01-11     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8804069     Medline TA:  Eur J Cardiothorac Surg     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  159-62     Citation Subset:  IM    
Copyright Information:
Copyright 2009 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.
Affiliation:
Division of Infectious Diseases, Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain. mlfernandez@fjd.es
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MeSH Terms
Descriptor/Qualifier:
Aged
Aortic Valve / microbiology,  surgery*,  ultrasonography
Echocardiography, Transesophageal
Endocarditis, Bacterial / microbiology,  surgery*,  ultrasonography
Female
Heart Valve Prosthesis / adverse effects*
Heart Valve Prosthesis Implantation / adverse effects,  methods*
Humans
Male
Middle Aged
Mitral Valve / microbiology,  surgery*,  ultrasonography
Prosthesis-Related Infections / microbiology,  surgery*,  ultrasonography
Retrospective Studies
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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