Factors affecting the surgical management of infective endocarditis

David C. Cassada, Mark Moniz, Scott Stevens, Michael Freeman, Mitchell Goldman, George S. Schuchmann

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Congestive heart failure and septic embolism complicate the clinical course of patients with infective endocarditis (IE). This study reviews the clinical records of patients with systemic disease secondary to IE and stratifies their disease severity according to individual risk factors and medical, and surgical interventions. The hospital records of all patients presenting to our institution from 1992 through 1997 with heart valve destruction secondary to IE were reviewed. Ten patients with hemodynamically significant valve lesions were included in this study: seven with aortic valve disease and two with mitral valve disease, and one with combined aortic and mitral valve lesions. All were diagnosed by echocardiogram. All ten patients experienced systemic septic arterial emboli: four intracranial lesions, four visceral lesions, and three extremity arterial occlusive events. Two patients required peripheral arterial repair. Cultures revealed infection secondary to Staphylococcus aureus in five, Streptococcus species in three, Coxiella species in one, and an unidentified organism in one patient. Seven patients underwent valve replacement. Three patients died from their disease processes. Statistical significance was established by Wilcoxon rank analysis with a two-tailed P < 0.05. Patients with IE secondary to staphylococcal infections suffered a more acute and virulent disease process (P = 0.04), with a 40 per cent mortality rate in the first 48 hours. There was no increased incidence of embolization associated with longer duration of symptoms (P = 0.32). Surgical repair conferred improved clinical outcome as compared with no surgical intervention (P = 0.03). Improved patient outcome was associated with nonstaphylococcal infection (P = 0.02), and a successful initial antibiotic regimen (P = 0.03). Peripheral arterial repair was successful in both cases.

Original languageEnglish (US)
Pages (from-to)307-310
Number of pages4
JournalAmerican Surgeon
Volume65
Issue number4
StatePublished - Jan 1 1999

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Endocarditis
Embolism
Aortic Valve
Mitral Valve
Coxiella
Staphylococcal Infections
Aortic Diseases
Hospital Records
Heart Valves
Acute Disease
Streptococcus
Coinfection
Staphylococcus aureus
Extremities
Heart Failure
Anti-Bacterial Agents
Mortality

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Factors affecting the surgical management of infective endocarditis. / Cassada, David C.; Moniz, Mark; Stevens, Scott; Freeman, Michael; Goldman, Mitchell; Schuchmann, George S.

In: American Surgeon, Vol. 65, No. 4, 01.01.1999, p. 307-310.

Research output: Contribution to journalArticle

Cassada, David C. ; Moniz, Mark ; Stevens, Scott ; Freeman, Michael ; Goldman, Mitchell ; Schuchmann, George S. / Factors affecting the surgical management of infective endocarditis. In: American Surgeon. 1999 ; Vol. 65, No. 4. pp. 307-310.
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