Active endocarditis: Single institute experience

ACTIVE ENDOCARDITIS: 
SINGLE INSTITUTE 
EXPERIENCE 
HUNG DUNG VAN, THANH BINH PHAM, PHAN NGUYEN 
HO CHI MINH HEART INSTITUTE 
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 
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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 
VAN H DUNG-HNPTTMLN 2016-HCM 
 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 
VAN H DUNG-HNPTTMLN 2016-HCM 
PATIENT DISTRIBUTION (N=671) 
 Treatment Type N % 
Medical treatment 355 53 
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) 
- Streptococci spp. 25 (54.3) 
- Enterococci spp. 4 (8.7) 
- Candida albican 2 (4.3) 
- Others 5 (10.8) 
Hemoculture (+) = 46/75 (61.3%) 
VAN H DUNG-HNPTTMLN 2016-HCM 
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 
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VAN H DUNG-HNPTTMLN 2016-HCM 
VAN H DUNG-HNPTTMLN 2016-HCM 
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 
VAN H DUNG-HNPTTMLN 2016-HCM 
 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) 
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Discusion 
 Surgical Indication ( guideline of STS 2011)) 
 Timing of surgery ( guideline of ESC 2015) 
VAN H DUNG-HNPTTMLN 2016-HCM 
 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 
TRÂN TRỌNG CÁM ƠN 
VAN H DUNG-HNPTTMLN 2016-HCM