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Shonbin A.N., Bystrov D.O., Afonin B.O., Sorokin R.O.
Surgical Treatment of Infectious Endocarditis
Keywords: infectious endocarditis, native valve, prosthesis infection, microbiological pathogen, transesophageal echocardiography, lesion localization, results of treatment
Infectious endocarditis is one of extremely dangerous diseases. Despite the opportunities of modern medicine, hospital mortality in infectious endocarditis remains high. Most patients are operated on for urgent and emergency indications. the article presents 11 years of experience in surgical treatment of infectious endocarditis at the State Budgetary Healthcare Institution JSC "PGKB named after E.E. Volosevich" in the town of Arkhangelsk. the study included 169 patients with infectious endocarditis, verified based on the presence of criteria corresponding to the modified Duke criteria. Infectious endocarditis of native valves (group I) was compared to prosthetic endocarditis (group II). the operative risk according to the EuroScore I, II and STS scales was significantly higher in the group of patients with prosthetic infectious endocarditis (p < 0.001). Para-valve destructive changes were more common (p = 0.05) in the group of prosthetic infectious endocarditis. There were no statistically significant differences in the localization of infectious endocarditis (p > 0.05), however, multiple valve lesions were more often observed in infectious endocarditis of native valves (p = 0.05). a complicated postoperative period was detected in 41.9% of patients of group I and in 71.4% of group II (p = 0.05). Hospital mortality in group I was 3.4%, in group II – 9.5% (p < 0.001). the main cause of death in the postoperative period was acute cardiovascular insufficiency. Despite the fact that hospital mortality in the surgical treatment of active infectious endocarditis continues to be high, surgical intervention in active infectious endocarditis is the only effective method of treatment.
References
- Danilov A.I., Kozlov R.S., Kozlov S.N., Dekhnich A.V. Praktika vedeniya patsientov s infektsionnym endokarditom v Rossiiskoi Federatsii [The practice of the patients management with infective endocarditis in the Russian Federation]. Antibiotiki i khimioterapiya, 2017, no. 62 (1-2), pp. 30–34.
- Infektsionnyi endokardit i infektsiya vnutriserdechnykh ustroistv: klinicheskie rekomendatsii. 2021: utverzhdeny Minzdravom Rossii [Infective endocarditis and infection of intracardiac devices: clinical recommendations. 2021: approved by the Ministry of Health of Russia]. Available at: https://cr.minzdrav.gov.ru/-recomend/54_2.
- Danilov A.I., Kozlov S.N., Evseev A.V., Starkova A.E. et al. Praktika naznacheniya startovoi antimikrobnoi terapii infektsionnogo endokardita v g. Smolensk [The practice of assigning starting antimicrobial therapy of infective endocarditis in Smolensk]. Vestnik Smolenskoi gosudarstvennoi meditsinskoi akademii, 2019, vol. 18, no. 2, pp. 85–89.
- Shevchenko Yu.L., ed., Tyurin V.P. Infektsionnye endokardity. Rukovodstvo [Infective endocarditis. Manual]. Moscow, GEOTAR-Media Publ., 2012, 368 p.
- Irtyuga O.B., Chistyakova V.I., Tenchurina A.O., Solntsev V.N. et al. Chastota vyyavleniya i klinicheskaya znachimost’ latentnogo infektsionnogo endokardita u patsientov s aortal’nym stenozom [Detection rate and clinical significance of latent infective endocarditis in patients with aortic stenosis]. Rossiiskii kardiologicheskii zhurnal, 2019, no. 24 (11), pp. 10–15. DOI: 10.15829/1560-4071-2019-11-10-15.
- Chazov E.I., ed., Shevchenko Yu. L. Infektsionnyi endokardit. Rukovodstvo po kardiologii: v 4 tomakh, T. 4. Zabolevaniya serdechno-sosudistoi sistemy (II) [Infective endocarditis. Guide to cardiology in four volumes. Vol. 4. Diseases of the cardiovascular system (II)]. Moscow, Praktika Publ., 2014, 976 p.
- Baddour L.M., Wilson W.R., Bayer A.S., Fowler Jr. V.G., Tleyjeh I.M. et al. Infective endocarditis in adults: Diagnosis, antimicrobial therapy, and management of complications: a scientific statement for healthcare professionals from the American Heart Association. Circulation, 2015, vol. 132, no. 15, pp. 1435–1486.
- Cecchi E., Trinchero R., Imazio M., Forno D. et al. Are the Duke criteria really useful for the early bedside diagnosis of infective endocarditis? Results of a prospective multicenter trial. Italian heart journal : official journal of the Italian Federation of Cardiology, 2005, no. 1(6), pp. 41–48.
- Chirillo F. New approach to managing infective endocarditis. Trends Cardiovasc Med., 2021, vol. 31 (5), pp. 277–286. DOI: 10.1016/j.tcm.2020.04.008.
- Durack D.T., Lukes A.S., Bright D.K. New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Duke Endocarditis Service. Am J Med., 1994, vol. 96(3), pp. 200–209. DOI: 10.1016/0002-9343(94)90143-0.
- Duval X., Leport C. Prophylaxis of infective endocarditis: current tendencies, continuing controversies. Lancet Infect Dis., 2008, vol. 8(4), pp. 225–232. DOI: 10.1016/S1473-3099(08)70064-1.
- Habib G., Lancellotti P., Antunes M.J., Bongiorni M.G. et al. ESC Scientific Document Group. 2015 ESC Guidelines for the management of infective endocarditis: the Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Heart J., 2015, vol. 36(44), pp. 3075–3128. DOI: 10.1093/eurheartj/ehv319.
About authors
- Shonbin Alexey N.
- Candidate of Medical Sciences, Associate Professor, Department of Surgery, Northern State Medical University; Head of the Department of Cardiac Surgery, First City Clinical Hospital named after I.I. Volosevich, Russia, Arkhangelsk (anshonbin@gmail.com; ORCID: https://orcid.org/0000-0002-1361-7945)
- Bystrov Dmitry O.
- Candidate of Medical Sciences, Assistant Lecturer, Department of Surgery, Northern State Medical University; Cardiovascular Surgeon of the Department of Cardiac Surgery, First City Clinical Hospital named after I.I. Volosevich, Russia, Arkhangelsk (dr.bystrov@gmail.com; ORCID: https://orcid.org/0000-0002-4909-4381)
- Afonin Boris O.
- Cardiovascular Surgeon, Department of Cardiac Surgery, First City Clinical Hospital named after I.I. Volosevich, Russia, Arkhangelsk (sheomf@yandex.ru; ORCID: https://orcid.org/0000-0002-6022-1126)
- Sorokin Roman O.
- Master of Public Health, Assistant Lecturer, Department of Surgery, Northern State Medical University; Cardiovascular Surgeon, Department of Cardiac Surgery, First City Clinical Hospital named after I.I. Volosevich, Russia, Arkhangelsk (don.sorokin2009@yandex.ru; ORCID: https://orcid.org/0000-0003-0835-4244)
Article link
Shonbin A.N., Bystrov D.O., Afonin B.O., Sorokin R.O. Surgical Treatment of Infectious Endocarditis [Electronic resource] // Acta medica Eurasica. – 2022. – №4. P. 73-79. – URL: https://acta-medica-eurasica.ru/en/single/2022/4/8/. DOI: 10.47026/2413-4864-2022-4-73-79.