Evaluation of Strategies in the Management of Infective Aortic Valve Endocarditis at German Cardiac Surgical Departments

Abstract

Background Surgical treatment of infective aortic valve endocarditis (AVE) remains a therapeutic challenge, necessitating interdisciplinary approach to limit morbidity and mortality in this high-risk cohort. With a considerable spectrum of available laboratory testings, imaging techniques, as well as operative strategies developed in recent years, there is a lack of standardization across cardiac surgical departments in Germany. Thus, the optimal treatment strategy of AVE has yet to be defined.

Methods A nationwide survey on infective AVE was conducted, including 64 cardiac surgical departments responding to a 41-item questionnaire. The evaluation included common surgical practice, routine diagnostic steps, surgical techniques, perioperative medical treatment, as well as postoperative management.

Results Remarkable differences were observed among the participating institutions, including the following components of the treatment: (1) standardization and extent of the use of imaging techniques and (2) success rate in identification AVE-causing germs, (3) timing of operation in case of cerebral embolization, and (4) choice of valve prosthesis for aortic valve replacement for infective AVE.

Conclusion The findings of this survey underline the need for a nationwide registry to further elucidate the nature and course of AVE in Germany, as well as to serve as a solid basis for prospective trials, addressing the most important clinical purposes in the diagnosis and treatment of AVE.

Keywords

questionnaire - infective endocarditis - aortic valve - common practice - quality management

Note

This paper was presented at the 45th annual meeting of the German Society for Thoracic and Cardiovascular Surgery, Leipzig, February 2016.

• References

• 1 Nishimura RA, Otto CM, Bonow RO. , et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2017; 70 (02) 252-289
• 2 Habib G, Lancellotti P, Antunes MJ. , et al; ESC Scientific Document Group. 2015 ESC Guidelines for the management of infective endocarditis: the task force for the management of infective endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J 2015; 36 (44) 3075-3128
• 3 Nishimura RA, Otto CM, Bonow RO. , et al; American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014; 63 (22) 2438-2488
• 4 Nishimura RA, Carabello BA, Faxon DP. , et al. ACC/AHA 2008 guideline update on valvular heart disease: focused update on infective endocarditis: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 2008; 52 (08) 676-685
• 5 Delahaye F, Harbaoui B, Cart-Regal V, de Gevigney G. Recommendations on prophylaxis for infective endocarditis: dramatic changes over the past seven years. Arch Cardiovasc Dis 2009; 102 (03) 233-245
• 6 Beckmann A, Doebler K, Schaefer E, Koetting J, Gastmeier P, Graf K. Sternal surgical site infection prevention - is there any room for improvement?. Eur J Cardiothorac Surg 2011; 40 (02) 347-351
• 7 Beckmann A, Funkat AK, Lewandowski J. , et al. German Heart Surgery Report 2016: the Annual Updated Registry of the German Society for Thoracic and Cardiovascular Surgery. Thorac Cardiovasc Surg 2017; 65 (07) 505-518
• 8 Misfeld M, Girrbach F, Etz CD. , et al. Surgery for infective endocarditis complicated by cerebral embolism: a consecutive series of 375 patients. J Thorac Cardiovasc Surg 2014; 147 (06) 1837-1844
• 9 Iung B, Klein I, Mourvillier B. , et al; Study Group. Respective effects of early cerebral and abdominal magnetic resonance imaging on clinical decisions in infective endocarditis. Eur Heart J Cardiovasc Imaging 2012; 13 (08) 703-710
• 10 Meshaal MS, Kassem HH, Samir A, Zakaria A, Baghdady Y, Rizk HH. Impact of routine cerebral CT angiography on treatment decisions in infective endocarditis. PLoS One 2015; 10 (03) e0118616
• 11 Cooper HA, Thompson EC, Laureno R. , et al. Subclinical brain embolization in left-sided infective endocarditis: results from the evaluation by MRI of the brains of patients with left-sided intracardiac solid masses (EMBOLISM) pilot study. Circulation 2009; 120 (07) 585-591
• 12 Yanagawa B, Pettersson GB, Habib G. , et al. Surgical management of infective endocarditis complicated by embolic stroke: practical recommendations for clinicians. Circulation 2016; 134 (17) 1280-1292
• 13 Baddour LM, Wilson WR, Bayer AS. , et al; American Heart Association Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Young, Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and Stroke Council. Infective endocarditis in adults: diagnosis, antimicrobial therapy, and management of complications: a scientific statement for healthcare professionals from the American Heart Association. Circulation 2015; 132 (15) 1435-1486
• 14 Zhao DF, Seco M, Wu JJ. , et al. Mechanical versus bioprosthetic aortic valve replacement in middle-aged adults: a systematic review and meta-analysis. Ann Thorac Surg 2016; 102 (01) 315-327