Features of Surgical Treatment of Patients with Complicated Forms of Infective Endocarditis

Gennadiy Khubulava, Andrey Peleshok, Nazim Shikhverdiev, Vladimir Krivopalov, Dmitriy Ushakov, Valeriy Sizenko

Russian Military Medical Academy, Saint-Petersburg, Russia

Date, time and location: 2018.05.26 15:30, Congress Hall, 2F–B

Abstract

Aim:to study the features of symptoms, management, diagnosis and treatment of infective endocarditis (IE) in modern life.

Materials and methods: 350 cases of IE. Isolated destruction of aortic valve was in 144 patients, mitral valve – 96 patients, tricuspid valve – 87 patients. In 20 patients there was destruction of two valves, three valves were affected in 2 patients and in 1 case there was IE of four heart valves. Complications of IE were in 73 patients: cardiac complications (heart abscesses, myocardial infarctions, VSD or ASD) were in 20 patients; extracardiac complications (stroke, lung abscesses, pneumonia, peripheral arterial embolism, mycotic aneurysms, spleen abscesses) in 53 patients. For diagnosis IE we used ECHO, TEE, SPECT/CT imaging with radiolabelled white blood cells, MSCT, angio-CT.

Results: Inhospital mortality was 12% (42 patients). Surgical approach to the heart in 306 patients was right-sided thoracotomy. In 44 patients full median sternotomy was used. We used valve replacement in all cases of IE of aortic valveю. Valve repair in patients with IE of mitral valve was done in 27 cases, in 69 cases we made valve replacement. Valve repair in patients with IE of tricuspid valve was done in 31 cases, in 56 cases we made valve replacement. Mean term for management patients with stroke before surgery was 6 weeks for patients with ischemic stroke andwith hemorrhagic stroke 9,5 weeks. Criteria for the possibility of surgical intervention in patients with pleuropulmonary complications were: 1) absence of gross disturbances in the spirogram and their positive dynamics 2) the absence of fresh purulent-destructive changes in the pleural cavities and lungs.

Conclusion: expansion of indications for surgery in patients with extracardiac complications; sparing principle of operations associated with the use of less traumatic approach and the desire to perform valve repair procedures; introduction of advanced medical technologies for diagnosis and treatment of IE.