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ACTIVE ENDOCARDITIS: SINGLE INSTITUTE EXPERIENCE... DESIGN OF STUDY  Retrospective study  All infective endocarditis patients who were operated from 1995 to 2015 at HoChiMinh Heart

ACTIVE ENDOCARDITIS:

SINGLE INSTITUTE

EXPERIENCE

BACKGROUND

 Endocarditis in native or prosthetic valve

 Endocarditis in congenital patients

 Treatment : combined

+ medical

+ surgical : who, when and how

+ transplantation

Active endocarditis : still infection of a native or prosthetic heart valve, the endocardial surface,

or an indwelling cardiac device

VAN H DUNG-HNPTTMLN 2016-HCM

DESIGN OF STUDY

 Retrospective study

 All infective endocarditis patients who were

operated from 1995 to 2015 at HoChiMinh

Heart Institute

 Focus on 75 pts who were operated in 2day-2

weeks from admission

Diagnosis and Treatment of Infective Endocarditis Guideline 2014 AHA/ACC

Echocardiography

Echocardiographic findings in

IE

 Vegetation

 Abscess

 Pseudoaneurysm

 Perforation

 Fistula

 Valve aneurysm

 Dishence of prosthetic valve

PATIENT DISTRIBUTION (N=671)

Surgical treatment : stable IE

active IE

241

75

36

11

VAN H DUNG-HNPTTMLN 2016-HCM

Pathogen of IE

Pathogens N (%)

- Staphylococus aureus 10 (21.7)

Hemoculture (+) = 46/75 (61.3%)

Patients demographic

 Male/female

 Mean age

 Vegetation : 97.3% ( echo : 100%)

 Annular abscess : 26 : aortic : 19 (3 native)

mitral : 6

pulmonic : 1

VAN H DUNG-HNPTTMLN 2016-HCM

Classification by pathology

Pathology N Position

Aortic Mitral Pulmonic Others Congenital 18 3 2 13 Acquired Val 30 16 14

Native Val 05 4 1

Prosthetic Val 20 16 4

Permanent

Electrode

2

VAN H DUNG-HNPTTMLN 2016-HCM

Surgical Procedure

 Defect Repair : 18

 Valvuloplasty : 16

 Rescontruction by pericardium and valve

replace : 32

 Bentall : 4

 Electrode remove + tricuspid plasty : 2

 CABG associated : 2

Mortality and Redo

 Operative mortality : 6 (8%) ( 3 cerebral

hemorrhage , 2 MOF and 1 LCO )

 Redo in first 3 months : 12

+ Ring dehiscense : 3

+ Valve prosthesis desinsertion : 9

( 5 cases IE relapse multiple  modified Bentall – 3 death)

VAN H DUNG-HNPTTMLN 2016-HCM

Follow up

 Median time of FU : 9 years ( range from 3

months to 19 years)

 Late death : 5 ( 4 LCO and 1 sudden death )

 Late IE recur ( > 1 y) : 5 ( 4 redo and 2 death)

Discusion

 Surgical Indication ( guideline of STS 2011))

 Timing of surgery ( guideline of ESC 2015)

VAN H DUNG-HNPTTMLN 2016-HCM

Conclusion

 Surgical Indication should be based on clinical

manifestation + IE ’ s nature

 Early surgery in some condition like annular

abscess, uncontrol HF, uncontrol infection, big vegetation…

 Our study showed that the result of early

surgery for active endocarditis is good in

intermediate and long-term FU

VAN H DUNG-HNPTTMLN 2016-HCM

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