General: Infective Endocarditis

Decision making re: surgery and its timing in acute infective endocarditis:

1) Eur J Cardiothorac Surg 2009;35:130-5. Hickey EJ, et al. (Toronto group)
Authors report surgical experience of 30 children operated for endocarditis in the past 30 years (1978-2007). Strep. viridans was noted predominantly with known cardiac defects. Staph. aureus was associated with abscess formation, clinical sepsis, acute deterioration and death. Aortic, mitral and tricuspid valves were involved with equal frequency. Pulmonary valve involvement was rare. Native valve was preserved in 22 children (73%). Univariate predictors of valve replacement were increased valve thickening and septic emboli (Severity of valve regurgitation was not predictive). Good paper.

2) Circulation 2010;121:1005-13. Lalani T, et al. Analysis of impact of early Surgery on in-hospital mortality of native valve endocarditis.
Data from an international registry. Non-randomized, retrospective study. So, of limited help. But, still useful information from a large cohort. Conclusion is that early surgery for native valve endocarditis has benefit of lower mortality compared to medical therapy alone. (Defn. of early surgery is replacement or repair of valve during initial hospitalization for IE).
...Read als0, the editorial on this article at Circulation 2010;121:960-2.

3) European guidelines for prevention, diagnosis and treatment of infective endocarditis. Quite useful. Eur Heart J 2009;30:2369-2413.

4) American Heart Association Guidelines:
(i) ACC/AHA 2008 Guideline Update on Valvar Heart Disease: Focus on infective endocarditis. Circulation 2008;118:887-896.
(ii) ACC/AHA 2005 Guideline: "Infective Endocarditis: Diagnosis, Antimicrobial therapy and management of complications" Circulation 2005;111:3167-3184. Or, the full text version (44 pages long) from AHA website.

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