Abstract
The prevalence of valvular infective endocarditis (IE) is increasing and is burdened by high mortality and morbidity. Despite the higher risk, the surgical approach is superior to medical therapy alone, and over the years there has been a more aggressive attitude, with earlier indications for surgery. This article aims to review the available literature and the American and European guidelines in order to summarize the most appropriate surgical timing for valvular IE. Although there are discrepancies between the guidelines, an emergent indication (15-20 mm). Patients with signs of heart failure, persistence of positive cultures for more than 48-72 h despite antibiotic therapy, and in the presence of paravalvular lesions, advanced atrioventricular block and vegetations >10 mm should be operated early (within a few days). If any micro-organisms are isolated, including fungi or multi-resistant organisms in native IE or staphylococci or gram-negative pathogens in prosthesis IE, a more watchful approach (within 2 weeks) should be evaluated. In the presence of large cerebral embolic strokes or cerebral hemorrhage, re-evaluation at 2 and 4 weeks, respectively, is more appropriate. A multidisciplinary approach, especially in the most complex cases, seems to improve the outcome.
Translated title of the contribution | Surgical timing in infective valvular endocarditis |
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Original language | Italian |
Pages (from-to) | 890-895 |
Number of pages | 6 |
Journal | Giornale Italiano di Cardiologia |
Volume | 21 |
Issue number | 11 |
DOIs | |
Publication status | Published - Nov 2020 |
Keywords
- Heart valve dysfunction
- Heart valve repair
- Heart valve replacement
- Heart valve surgery
- Infective endocarditis
- Timing of surgery
- EARLY SURGERY
- ANTIBIOTIC-THERAPY
- CARDIAC-SURGERY
- VALVE
- MORTALITY
- IMPACT
- RISK
- ASSOCIATION
- GUIDELINES
- MANAGEMENT
- COMPLICATIONS