Infective endocarditis (IE) is nowadays one of the most challenging disease in cardiac surgery because of its multifaceted clinical and anatomical presentation. Despite the many clinical and surgical advances achieved in the past 60 years, there is a lack of evidence regarding the ideal strategy. The present review aims to investigate and highlight two main novel concepts for the decision-making of the best substitute. Firstly, the concept of an "endocarditis team": a coordinated multidisciplinary effort in the diagnostic work-up, especially in conditions of high risk of embolization or clinical deterioration. A good "endocarditis team" has the role to overcome such problem, in order to ensure a prompt and balanced strategy. Secondly, which ethical considerations are required to drive the choice of valvular substitute. The choice of best valve substitute is a relevant issue of debate, not only with operative but also prognostic and accordingly ethical aftermaths. Many different solutions have been developed to substitute the infected valve. Among these: mechanical prosthesis (MP), biological stented prosthesis (BP), sutureless bioprosthesis and cryopreserved homografts (CHs). Patients need to be informed in detail about the technical issues pertaining the use of these valve substitute. We will discuss the evidences regarding the risk of recurrent infections or future potentially severe calcification of aortic homograft valve and wall (in other words, the failure of the homograft) and the difficulties in managing the reoperation.
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http://dx.doi.org/10.21037/atm-20-4626 | DOI Listing |
Port J Card Thorac Vasc Surg
January 2025
Division of Cardiovascular Surgery, Temple University Hospital, Philadelphia, Pennsylvania. USA.
Infective endocarditis carries a high risk of morbidity and mortality with recurrent infections and non-compliance. In the case of right-sided endocarditis, the indications for intervention are less clear. The Angiovac procedure provides a treatment for right-sided endocarditis that is a less-invasive and ideal for a complicated patient population.
View Article and Find Full Text PDFViruses
January 2025
Service des Maladies Infectieuses et Tropicales, Hôpital Pitié Salpêtrière, APHP Sorbonne Université, 75013 Paris, France.
Phage therapy is experiencing renewed interest, particularly for antibiotic-resistant infections, and may also be useful for difficult-to-treat cases where surgery to remove foreign infected material is deemed too risky. We report a case of recurrent endocarditis with Bentall infection treated successfully with a combination of antibiotics and phages.
View Article and Find Full Text PDFPathogens
December 2024
Intensive Care Unit, Department of Anesthesiology and Critical Care, AHEPA University Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece.
Ventriculo-meningitis or nosocomial meningitis/ventriculitis is a severe nosocomial infection that is associated with devastating neurological sequelae. The cerebrospinal fluid isolates associated with the infection can be Gram-positive or -negative, while the spp. is rarely identified.
View Article and Find Full Text PDFJ Clin Med
January 2025
Department of Surgery, Dentistry, Pediatrics and Gynecology, Division of Cardiac Surgery, University of Verona, 37126 Verona, Italy.
Previous studies evaluated the prognostic role of hematological parameters in predicting outcome in patients with infective endocarditis (IE). However, only a few studies evaluated the role of hematological parameters in patients undergoing surgery for IE. The aim of this study was to review our 20-year experience with the treatment of native (NVE) and prosthetic (PVE) valve endocarditis and to evaluate the role of neutrophil-to-lymphocyte ratio (NLR), neutrophil-to-platelet ratio (NPR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), neutrophil-to monocyte ratio (NMR), and systemic inflammatory index (SII) on early and long-term outcomes of patients undergoing surgery for NVE and PVE.
View Article and Find Full Text PDFMedicina (Kaunas)
January 2025
Department of Infectious Diseases, "St. Parascheva" Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania.
: Infective endocarditis (IE) is a severe, life-threatening infection of the endocardial surface. Its incidence has shifted towards older, immunocompromised patients and those with cardiac devices. : This study was conducted at the "Sf.
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