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Delos M Cosgrove - One of the best experts on this subject based on the ideXlab platform.
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Surgical treatment of Prosthetic Valve Endocarditis
The Journal of thoracic and cardiovascular surgery, 1996Co-Authors: Bruce W Lytle, Derek D Muehrcke, Brian P. Priest, Paul C. Taylor, Floyd D. Loop, Shelley K. Sapp, Robert W. Stewart, Patrick M. Mccarthy, Delos M CosgroveAbstract:From 1975 through 1992, we reoperated on 146 patients for the treatment of Prosthetic Valve Endocarditis. Prosthetic Valve Endocarditis was considered to be early (< 1 year after operation) in 46 cases and active in 103 cases. The extent of the infection was prosthesis only in 66 patients, anulus in 46, and cardiac invasion in 34. Surgical techniques evolved in the direction of increasingly radical debridement of infected tissue and reconstruction with biologic materials. All patients were treated with prolonged postoperative antibiotic therapy. There were 19 (13%) in-hospital deaths. Univariate analyses demonstrated trends toward increasing risk for patients with active Endocarditis and extension of infection beyond the prosthesis; however, the only variables with a significant (p < 0.05) association with increased in-hospital mortality confirmed with multivariate testing were impaired left ventricular function, preoperative heart block, coronary artery disease, and culture of organisms from the surgical specimen. During the study period, mortality decreased from 20% (1975 to 1984) to 10% (1984 to 1992). For hospital survivors the mean length of stay was 25 days. Follow-up (mean interval 62 months) documented a late survival of 82% at 5 postoperative years and 60% at 10 years. Older age was the only factor associated (p = 0.006) with late death. Nineteen patients needed at least one further operation; reoperation-free survival was 75% at 5 and 50% at 10 postoperative years. Fever in the immediate preoperative period was the only factor associated with decreased late reoperation-free survival (p = 0.032). Prosthetic Valve Endocarditis remains a serious complication of Valve replacement, but the in-hospital mortality of reoperations for Prosthetic Valve Endocarditis has declined. With extensive debridement of infected tissue and postoperative antibiotic therapy, the extent and activity of Prosthetic Valve Endocarditis does not appear to have a major impact on late outcome, and the majority of patients with this complication survive for 10 years after the operation.
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surgical and long term antifungal therapy for fungal Prosthetic Valve Endocarditis
The Annals of Thoracic Surgery, 1995Co-Authors: Derek D Muehrcke, Bruce W Lytle, Delos M CosgroveAbstract:Background. Fungal Prosthetic Valve Endocarditis is an uncommon but serious disease. We have developed a strategy of treatment that includes perioperative amphotericin B, radical debridement of infected tissue, reconstruction using biologic tissue when possible, and prolonged oral suppressive antifungal therapy. Methods. We retrospectively reviewed the charts of 12 patients reoperated on for fungal Prosthetic Valve Endocarditis involving the aortic Valve (10 patients: six porcine Valves, two mechanical Valves, two homografts) and the mitral Valve (2 patients, both porcine Valves). Prosthetic Valve Endocarditis developed in 7 within 12 months after the first Valve procedure. The organisms included Candida species (9 patients), Scopulariopsis brevicaulis (1), Saccharomyces cervisiae (1), and histoplasmosis (1). Results. At operation, all patients had Prosthetic vegetations, 8 had abscesses, and 4 had sinus tracts. Seven received aortic homografts, 4 received porcine Valves (two mitral), and 1 received a mechanical prosthesis. Two patients died in the hospital after prolonged illnesses (83% hospital survival). Four patients had recurrence an average of 25 months later and 3 underwent further surgical intervention. One patient had recurrence and died 17 months postoperatively. One other late death occurred 96 months after operation, and there was no evidence of recurrence. Eight patients (67%) are alive and well 51.5 ± 61.0 months (range, 1 to 189 months) after the first redo procedure for fungal Prosthetic Valve Endocarditis. Conclusions. We conclude that preoperative treatment with amphotericin B, radical resection of all infected tissue, cardiac reconstruction using biologic tissue when possible, and life-long oral antifungal therapy is effective for fungal Prosthetic Valve Endocarditis.
James H. Maguire - One of the best experts on this subject based on the ideXlab platform.
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Salmonella Prosthetic Valve Endocarditis
Diagnostic microbiology and infectious disease, 1992Co-Authors: Peter W. Choo, Nelson M. Gantz, Charles Anderson, James H. MaguireAbstract:Four cases of Salmonella Prosthetic Valve Endocarditis have been reported previously in the English medical literature (Fraser et al. 1967; Yamamoto et al., 1974; Shanson et al., 1977; Bassa et al., 1989). This report describes a fifth case in a 62-year-old woman who developed tricuspid Valve Endocarditis after an episode of Salmonella gastroenteritis, and reviews prior cases of Salmonella Prosthetic Valve Endocarditis.
Larry M. Baddour - One of the best experts on this subject based on the ideXlab platform.
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Early Surgery for Prosthetic Valve Endocarditis
NEJM Journal Watch, 2013Co-Authors: Larry M. BaddourAbstract:No randomized trials have been conducted to examine the role and timing of Valve surgery in patients with Prosthetic Valve Endocarditis (PVE). This aspect of Endocarditis management is critical and is being used more today than in the past. Now, International Collaboration on Endocarditis–Prospective Cohort Study investigators have examined data prospectively collected between 2000 and 2006 from 64 medical centers in …
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Prosthetic Valve Endocarditis: clinicopathological correlates in 122 surgical specimens from 116 patients (1985-2004).
Cardiovascular pathology : the official journal of the Society for Cardiovascular Pathology, 2011Co-Authors: Jonathan H. Lee, Kimberly D. Burner, Michael E. Fealey, William D. Edwards, Henry D. Tazelaar, Thomas A. Orszulak, Alan J. Wright, Larry M. BaddourAbstract:Abstract Background Few studies have documented the clinicopathological features of Prosthetic Valve Endocarditis independently of native Valve Endocarditis. Study Design Retrospective analysis of patients undergoing cardiac surgery for Prosthetic Valve Endocarditis at our institution (1985–2004). Methods Medical records and microscopic slides were reviewed from 116 patients for demographics, infecting organisms, comorbidities, and pathologic features. Results Patients were 12–86 years old (mean, 59 years). Among 122 Valves, 64% were from men and 67% were purely regurgitant. Aortic Prosthetic Valve Endocarditis frequently affected men (76%); mitral Prosthetic Valve Endocarditis often affected women (62%). Embolization occurred in 35% and heart failure in 32%. Prevalent predisposing conditions were the Prosthetic Valve alone (43%) and diabetes mellitus (20%). Prosthetic Valve Endocarditis was aortic or mitral in 98% and was active in 70%. Annular abscess or paravalvular leak affected mechanical Valves more frequently than bioProsthetic (89% vs. 65%; P=.001). Causative organisms (n=116) included Staphylococcus aureus (30%), coagulase-negative staphylococcus (22%), viridans streptococci (18%), enterococci (10%), other streptococci (8%), and other organisms (12%). S. aureus was the most prevalent cause of early-onset (38%) and late-onset (30%) Prosthetic Valve Endocarditis. Coagulase-negative staphylococcus caused early-onset (31%) and most intermediate-onset (40%) disease and had a shorter median implantation-to-infection time than other organisms (6.5 vs. 61.3 months; P Conclusions Cocci accounted for 83% of infections. Early-onset Prosthetic Valve Endocarditis was primarily staphylococcal, and late-onset Prosthetic Valve Endocarditis resembled native Valve Endocarditis. Both Gram and Grocott methenamine silver stains were necessary to reliably identify organisms microscopically.
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medical versus surgical management of staphylococcus aureus Prosthetic Valve Endocarditis
The American Journal of Medicine, 2006Co-Authors: Muhammad R Sohail, Walter R. Wilson, Larry M. Baddour, Kyle R Martin, William S Harmsen, James M SteckelbergAbstract:Purpose The study's purpose was to identify prognostic factors associated with mortality in Staphylococcus aureus Prosthetic Valve Endocarditis and to determine whether these factors influenced decisions to treat medically versus surgically. We also analyzed whether there was a subset of patients who were cured with medical therapy alone. Subjects and methods A retrospective review of patients with S aureus Prosthetic Valve Endocarditis was performed. Demographic and clinical data were collected from existing medical records. Severity of illness was classified using American Society of Anesthesiologists (ASA) score. Impact of treatment on in-hospital mortality was assessed using multiple logistic regression analysis. Results Fifty-five patients met the Duke criteria for definite S aureus Prosthetic Valve Endocarditis. Twenty-three patients were treated medically, and 32 patients had surgical intervention. Overall mortality was 36% (28% in the surgical group and 48% in the medical group). ASA score IV ( P P = .014) were significant risk factors of mortality. Patients with ASA score IV ( P = .037) and multiple Prosthetic Valves ( P = .013) were less likely to undergo surgery. Medically treated patients were older compared with those in the surgical group (median age 66 vs 55 years, P = .04). All 4 patients aged less than 50 years in the medically treated group survived. Conclusion Mortality was generally higher in the medically treated patients with S aureus Prosthetic Valve Endocarditis. Multivariable analysis showed that ASA class IV and bioProsthetic Valves were independent predictors of mortality. A subset of medically treated patients characterized by age less than 50 years, ASA score III, and without cardiac, central nervous system, or systemic complications were cured without surgical intervention.
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long term suppressive therapy for candida parapsilosis induced Prosthetic Valve Endocarditis
Mayo Clinic Proceedings, 1995Co-Authors: Larry M. BaddourAbstract:Prompt Valve replacement is advocated in patients in whom candidal Prosthetic Valve Endocarditis develops. Unfortunately, some patients with this condition are considered nonsurgical candidates, and they are unable to tolerate long-term administration of amphotericin B with or without flucytosine. Herein we describe a patient with Candida parapsilosis-induced Prosthetic Valve Endocarditis in whom oral administration of fluconazole during an 11-month period successfully suppressed the fungal infection. Three previously published cases indicate that long-term noncurative suppressive therapy for C. parapsilosis-induced Prosthetic Valve Endocarditis may allow prolonged symptom-free survival for such patients.
Ulla Hohenthal - One of the best experts on this subject based on the ideXlab platform.
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Capnocytophaga canimorsus: a rare case of conservatively treated Prosthetic Valve Endocarditis.
APMIS : acta pathologica microbiologica et immunologica Scandinavica, 2018Co-Authors: Päivi Jalava-karvinen, Juha Grönroos, Helena Tuunanen, Jukka Kemppainen, Jarmo Oksi, Ulla HohenthalAbstract:We describe a rare case of Prosthetic Valve Endocarditis caused by the canine bacterium Capnocytophaga canimorsus in a male aged 73 years. The diagnosis of infective Endocarditis was unequivocal, as it blood cultures were positive for C. canimorsus and vegetations were detected on transesophageal echocardiography; the modified Duke criteria were fulfilled. PET-CT showed intense 18 F-FDG uptake of the Prosthetic Valve area. The patient was treated with antibiotics alone (no surgery), and is now on life-long suppressive antibiotic therapy. To our knowledge, this is the third reported case of Prosthetic Valve Endocarditis caused by C. canimorsus and the first one to have been treated conservatively.
Bruce W Lytle - One of the best experts on this subject based on the ideXlab platform.
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Surgical treatment of Prosthetic Valve Endocarditis
The Journal of thoracic and cardiovascular surgery, 1996Co-Authors: Bruce W Lytle, Derek D Muehrcke, Brian P. Priest, Paul C. Taylor, Floyd D. Loop, Shelley K. Sapp, Robert W. Stewart, Patrick M. Mccarthy, Delos M CosgroveAbstract:From 1975 through 1992, we reoperated on 146 patients for the treatment of Prosthetic Valve Endocarditis. Prosthetic Valve Endocarditis was considered to be early (< 1 year after operation) in 46 cases and active in 103 cases. The extent of the infection was prosthesis only in 66 patients, anulus in 46, and cardiac invasion in 34. Surgical techniques evolved in the direction of increasingly radical debridement of infected tissue and reconstruction with biologic materials. All patients were treated with prolonged postoperative antibiotic therapy. There were 19 (13%) in-hospital deaths. Univariate analyses demonstrated trends toward increasing risk for patients with active Endocarditis and extension of infection beyond the prosthesis; however, the only variables with a significant (p < 0.05) association with increased in-hospital mortality confirmed with multivariate testing were impaired left ventricular function, preoperative heart block, coronary artery disease, and culture of organisms from the surgical specimen. During the study period, mortality decreased from 20% (1975 to 1984) to 10% (1984 to 1992). For hospital survivors the mean length of stay was 25 days. Follow-up (mean interval 62 months) documented a late survival of 82% at 5 postoperative years and 60% at 10 years. Older age was the only factor associated (p = 0.006) with late death. Nineteen patients needed at least one further operation; reoperation-free survival was 75% at 5 and 50% at 10 postoperative years. Fever in the immediate preoperative period was the only factor associated with decreased late reoperation-free survival (p = 0.032). Prosthetic Valve Endocarditis remains a serious complication of Valve replacement, but the in-hospital mortality of reoperations for Prosthetic Valve Endocarditis has declined. With extensive debridement of infected tissue and postoperative antibiotic therapy, the extent and activity of Prosthetic Valve Endocarditis does not appear to have a major impact on late outcome, and the majority of patients with this complication survive for 10 years after the operation.
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surgical and long term antifungal therapy for fungal Prosthetic Valve Endocarditis
The Annals of Thoracic Surgery, 1995Co-Authors: Derek D Muehrcke, Bruce W Lytle, Delos M CosgroveAbstract:Background. Fungal Prosthetic Valve Endocarditis is an uncommon but serious disease. We have developed a strategy of treatment that includes perioperative amphotericin B, radical debridement of infected tissue, reconstruction using biologic tissue when possible, and prolonged oral suppressive antifungal therapy. Methods. We retrospectively reviewed the charts of 12 patients reoperated on for fungal Prosthetic Valve Endocarditis involving the aortic Valve (10 patients: six porcine Valves, two mechanical Valves, two homografts) and the mitral Valve (2 patients, both porcine Valves). Prosthetic Valve Endocarditis developed in 7 within 12 months after the first Valve procedure. The organisms included Candida species (9 patients), Scopulariopsis brevicaulis (1), Saccharomyces cervisiae (1), and histoplasmosis (1). Results. At operation, all patients had Prosthetic vegetations, 8 had abscesses, and 4 had sinus tracts. Seven received aortic homografts, 4 received porcine Valves (two mitral), and 1 received a mechanical prosthesis. Two patients died in the hospital after prolonged illnesses (83% hospital survival). Four patients had recurrence an average of 25 months later and 3 underwent further surgical intervention. One patient had recurrence and died 17 months postoperatively. One other late death occurred 96 months after operation, and there was no evidence of recurrence. Eight patients (67%) are alive and well 51.5 ± 61.0 months (range, 1 to 189 months) after the first redo procedure for fungal Prosthetic Valve Endocarditis. Conclusions. We conclude that preoperative treatment with amphotericin B, radical resection of all infected tissue, cardiac reconstruction using biologic tissue when possible, and life-long oral antifungal therapy is effective for fungal Prosthetic Valve Endocarditis.
