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surgical outcome of native valve infective endocarditis in srinagarind hospital 2004-2005

surgical outcome of native valve infective endocarditis in srinagarind hospital 2004-2005. Worawit Intanoo MD. Sompop pratanee MD. Cardiovascular- thoracic unit, Department of surgery, Khonkaen university. Background.

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surgical outcome of native valve infective endocarditis in srinagarind hospital 2004-2005

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  1. surgical outcome of native valve infective endocarditis in srinagarind hospital2004-2005

  2. Worawit Intanoo MD. Sompop pratanee MD. Cardiovascular- thoracic unit, Department of surgery, Khonkaen university

  3. Background • Native valve infective endocarditis (NVE) is associated with a myriad of complications. • Khonkaen prevalence was 4 patients per 1,000 hospital admissions. • In-hospital mortality was 25 per cent. • During the first month after admission, 45 per cent of the patients underwent surgery. • Pachirat O et al . Infective endocarditis: prevalence, characteristics and mortality in Khon Kaen, 1990-1999. J Med Assoc Thai. 2002 Jan;85(1):1-10.

  4. Background • During the last three decades, valve replacement and even valve repair have become commonplace in the management of selected complications of NVE. • Valve surgery was associated with reduced mortality. Vikram HR et al. Impact of valve surgery on 6 month mortality in adult with complicated, left sided native valve endocarditis. JAMA 2003 Dec 24;290(24):3207-14

  5. Indication for surgery • valve dysfunction leading to heart failure (1B) • infection with difficult to treat pathogens (1C) • valve destruction resulting in severe regurgitation with hemodynamic evidence of elevated left ventricular end-diastolic or left atrial pressures (1C) the 2006 American College of Cardiology/American Heart Association (ACC/AHA) guidelines

  6. Indication for surgery • persistent infection, including paravalvular abscess (1C) • embolic events while on an appropriate antibiotic regimen OR associated with a large vegetation (2C) • mobile, large (>10 mm) left sided vegetations with or without emboli (IIC) the 2006 American College of Cardiology/American Heart Association (ACC/AHA) guidelines

  7. Methodology • Retrospective Descriptive study • January 2004 – December 2005 • 23 NVE patients

  8. Demographic data

  9. Demographic data Dyspnea status

  10. Diagnostic tool

  11. organism

  12. operation

  13. outcome

  14. summary • NVE is not uncommon condition in srinagarind hospital. • Hospital mortality rate is still high.

  15. discussion • Consideration for surgery in patients with native valve endocarditis must involve a decision analysis that balances the risks of medical treatment with those of surgical intervention, including • operative mortality and morbidity, • recurrent embolization, • co-morbidities, • the long-term complications of valvular prostheses and anticoagulation.

  16. discussion • Surgery should not be delayed to complete antimicrobial therapy in patients with progressive HF or evidence of other complications.

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