Chapter 118. Infective Endocarditis (Part 10)

Table 118-5 Indications for Cardiac Surgical Intervention in Patients with EndocarditisSurgery required for optimal outcomeModerate to severe congestive heart failure due to valve dysfunctionPartially dehisced unstable prosthetic valvePersistent bacteremia despite optimal antimicrobial therapyLackofeffectivemicrobicidaltherapy(e.g.,fungalorBrucella endocarditis)S. aureus prosthetic valve endocarditis with an intracardiac complicationRelapse of prosthetic valve endocarditis after optimal antimicrobial therapySurgery to be strongly considered for improved outcomeaPerivalvular extension of infectionPoorly responsive S. aureus endocarditis involving the aortic or mitral valveLarge (10-mm diameter) hypermobile vegetations with increased risk of embolism ...
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Chapter 118. Infective Endocarditis (Part 10) Chapter 118. Infective Endocarditis (Part 10) Table 118-5 Indications for Cardiac Surgical Intervention in Patientswith Endocarditis Surgery required for optimal outcome Moderate to severe congestive heart failure due to valve dysfunction Partially dehisced unstable prosthetic valve Persistent bacteremia despite optimal antimicrobial therapy Lack of effective microbicidal therapy (e.g., fungal orBrucella endocarditis) S. aureus prosthetic valve endocarditis with an intracardiac complication Relapse of prosthetic valve endocarditis after optimal antimicrobialtherapy Surgery to be strongly considered for improved outcomea Perivalvular extension of infection Poorly responsive S. aureus endocarditis involving the aortic or mitralvalve Large (>10-mm diameter) hypermobile vegetations with increased risk ofembolism Persistent unexplained fever (≥10 days) in culture-negative native valveendocarditis Poorly responsive or relapsed endocarditis due to highly antibiotic-resistant enterococci or gram-negative bacilli a Surgery must be carefully considered; findings are often combined withother indications to prompt surgery. Table 118-6 Timing of Cardiac Surgical Intervention in Patients withEndocarditis Indication for Surgical Intervention Timing Strong Supporting Conflicting Evidence Evidence, but Majority of Opinions Favor Surgery Emergent Acute aortic(same day) regurgitation plus preclosure of mitral valve Sinus of Valsalva abscess ruptured into right heart Rupture into pericardial sac Urgent Valve obstruction by Major embolus plus(within 1–2 days) vegetation persisting large vegetation (>10 mm in diameter) Unstable (dehisced) prosthesis Acute aortic or mitral regurgitation with heart failure (New York Heart Association class III or IV) Septal perforation Perivalvular extension of infection with/without new electrocardiographic conduction system changes Lack of effective antibiotic therapy Elective Progressive paravalvular Staphylococcal PVE(earlier usually prosthetic regurgitationpreferred) Valve dysfunction plus Early PVE (≤2 persisting infection after ≥7–10 months after valve surgery) days of antimicrobial therapy Fungal (mold) Fungal endocarditis endocarditis (Candida spp.) Antibiotic-resistant organisms Abbreviation: PVE, prosthetic valve endocarditis. Source: Adapted from L Olaison, G Pettersson: Infect Dis Clin North Am16:453, 2002.