Although this destructive pathology is increasing in incidence and prevalence — largely due to sepsis and infections in the growing number of patients receiving invasive treatments and prosthetic valves, as well as to injection-drug use — most cardiac surgeons see few cases in a given year. They assembled a multidisciplinary writing committee comprising staff from Cleveland Clinic and Dr. The committee produced a robust document, published in the June Journal of Thoracic and Cardiovascular Surgery , that details every aspect of IE care: the steps needed to identify the infection, proper tools to diagnose it, indications for and timing of surgery, the surgical procedure itself, perioperative management and the value of early surgeon involvement in team decision-making.
The full-length guidelines are preceded by a helpful executive summary. A: We wanted to construct an easy-to-use set of recommendations on specific questions that confront cardiac surgeons and their multidisciplinary team before, during and after surgery for IE. The questions are focused on active and suspected IE affecting valves and intracardiac structures.
We felt this would be best accomplished by framing our recommendations as answers to clinical questions particularly relevant to cardiac surgeons involved in IE treatment. But we present the recommendations in a conventional table format, grouped according to the questions they address, with each recommendation accompanied by its classification, level of evidence and supporting references.
The rationale is discussed in brief narrative form in the executive summary and at length in the full document. A: IE manifests itself as a systemic disease with systemic complications that make it difficult to diagnose and treat and which take time and experience to understand. In most cases management requires expertise from several specialties. Previous guidelines have been issued by cardiology and infectious disease societies, as well as by the Society of Thoracic Surgeons.
The AATS felt it would be helpful to condense the information in these guidelines into a single document and expand on it in areas specifically relevant to the care of patients requiring surgery. This document underscores the many angles to consider before taking a patient with IE to surgery. A: Antibiotic therapy is the cornerstone of care for these patients. Surgery is often needed to clean out the infection, and most patients with an infected prosthetic valve will require surgery.
We explain that if antibiotics are started before the vegetation becomes too large, IE can be cured. But antibiotics cannot restore the integrity of damaged tissues and valves.
If vegetations have grown large and the infection has penetrated the wall of the aorta or valve annulus, surgery is needed to remove the biofilm along with infected dead and foreign tissue and to restore valve function and cardiac integrity. A: In most IE patients with vegetations, infected material splits off and can embolize in any organ. Notably, emboli to the brain cause stroke.
In the guidelines we discuss how patients with large vegetations on their valves should be treated, their risk of emboli, what the risk-benefit ratio for operating should be, and the timing of surgery. Advertising on our site helps support our mission.
We do not endorse non-Cleveland Clinic products or services Policy. Vegetations visible on echo are the main source of embolism in patients with endocarditis. This post illustrates principles for how to evaluate them to gauge embolism likelihood. The first comprehensive multidisciplinary U. Pettersson in this interview on the new guidelines he co-chaired. A Cleveland Clinic team has uncovered strong evidence suggesting infective endocarditis is a biofilm-associated infection, explaining its resistance to nonsurgical treatments.
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