[Surgical intervention in infective endocarditis: indications and timing].
A major advance has occurred over recent decades in the treatment strategies for infective endocarditis (IE). A significant part of this progress is due to a clearer knowledge of IE insult patterns; especially those concerning valvular damage and resultant heart failure. Furthermore, the existence of IE unique vegetations ensuring a suitable platform for organism growth and partial antibiotic resistance, has led to an understanding of the limited capacity of antibiotics to treat IE. Accordingly, an increased emphasis on surgical intervention has emerged. Indeed, the last decades were characterized by increased attempts to explore the feasibility and efficacy of surgical approach in IE. The present review is a result of these attempts, summarizing the major indications for surgical intervention in IE, as was recently published by the American Heart Association. Generally, such intervention is warranted in IE complications including: hemodynamically significant valvular damage, paravalvular abscess, continuous infection despite optimal treatment, recurrent emboli and antibiotic-resistant organisms. Recognition of the prognostic influence of pre-treatment heart failure degree has led to the development of early surgical intervention, namely, surgical intervention during the active period of IE. Application of such early intervention has led to survival rates which are significantly higher than achieved by antibiotic treatment per se.
Department of Internal Medicine A, Hadassah Hospital, Hebrew University Medical School, Jerusalem. oritmoshe@yahoo.com
Moshe
M
Rav-Acha
David
D
Sassa
Yaron
Y
Ilan
Eli
E
Milgalter
Chaim
C
Lotan
D006348:Cardiac Surgical Procedures / Q000379:methods*; D004617:Embolism / Q000209:etiology; D004696:Endocarditis / Q000150:complications / Q000601:surgery*; D006801:Humans; D007239:Infections / Q000601:surgery*