Timing of Surgery and Clinical Outcomes of Isolated Right-heart Infective Endocarditis. A Single Center Experience
Journal Title: E Journal of Cardiovascular Medicine - Year 2019, Vol 7, Issue 4
Abstract
Objectives: Isolated infective endocarditis of the right heart is a rare clinical entity. I review our twelve-year experiences of the peri-operative features and surgical treatment of isolated right-sided infective endocarditis and long-term outcomes. Materials and Methods: Between January 2005 and June 2017, a total of 58 patients were operated for an isolated right-sided infective endocarditis in our tertiary center. Congenital heart defects were the main reasons. Previous pacemaker lead insertion, cardiac catheterization, use of central vein catheters for hemodialysis, and intravenous drug abuse were other risk factors. Seven patients have a history of active intravenous drug use (12%). The patients’ mean follow-up was 24.7±6.1 months. Results: Three patients died after surgery (5.1%) due to postoperative low out-put syndrome and uncontrolled septic shock after surgery. Two patients had chronic kidney disease and one used intravenous drug. Tricuspid valve repair or replacement was performed in 29 patients (50%). Mechanical and bioprosthetic heart valves were replaced in eight patients (13.7%). De Vega, Kay’s annuloplasty, or bicuspidization were performed in 21 patients (36.2%). Coagulase-negative staphylococci (n=14), Staphylococcus epidermidis (n=7), Streptococcus viridans (n=5), S. epidermidis (n=3), and Methicillin Resistance Staphylococcus aureus (n=3) were the most common microorganisms in pre-operative blood cultures. In the patients, who had a history of intravenous drug abuse (n=7), Enterococcus and fungi were the pathogens. Two patients (3.8%) required re-operation because of the recurrence of endocarditis, combined with severe tricuspid valve impairment seven months and one year after the first operation. The survival rate after operation was 30 days, and 1, 2, 5, and 10 years (94.2%, 88.9%, 82.5%, 81%, and 80%), respectively. Conclusion: Surgical outcomes of patients with isolated right-sided infective endocarditis, who underwent surgery in the early time, were favourable. We suggest extensive and an aggressive intervention when the patient have hemodynamic instability or the right heart failure which is resistant to medical treatment or large vegetation. Postoperative antibiotic treatment and medication are the key factors to avoid mortality and morbidity.
Authors and Affiliations
Ahmet Feyzi Abacılar
Keywords
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- EP ID EP675922
- DOI 10.32596/ejcm.galenos.2019.09.050
- Views 164
- Downloads 0
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