Kinh nghiệm điều trị phẫu thuật viêm nội tâm mạc nhiễm trùng cấp và bán cấp

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 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 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 (8.7) - Candida albican (4.3) - Others (10.8) Hemoculture (+) = 46/75 (61.3%) VAN H DUNG-HNPTTMLN 2016-HCM Patients demographic  Male/female  Mean age  Vegetation  Annular abscess : 97.3% ( echo : 100%) : 26 : aortic : 19 (3 native) mitral : pulmonic : VAN H DUNG-HNPTTMLN 2016-HCM Classification by pathology Pathology N Position Aortic Mitral Congenital 18 Acquired Val 30 16 14 Native Val 05 Prosthetic Val 20 16 Permanent Electrode VAN H DUNG-HNPTTMLN 2016-HCM Pulmonic Others 13 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 : CABG associated : VAN H DUNG-HNPTTMLN 2016-HCM Mortality and Redo  Operative mortality : (8%) ( cerebral hemorrhage , MOF and LCO )  Redo in first months : 12 + Ring dehiscense :3 + Valve prosthesis desinsertion : ( cases IE relapse multiple  modified Bentall – death) VAN H DUNG-HNPTTMLN 2016-HCM Follow up  Median time of FU : years ( range from months to 19 years)  Late death : ( LCO and sudden death )  Late IE recur ( > y) : ( redo and death) VAN H DUNG-HNPTTMLN 2016-HCM 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