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

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. Native valve infective endocarditis (NVE) is associated with a myriad of complications. Khonkaen prevalence was 4 patients per 1,000 hospital admissions. Khonkaen prevalence was 4 patients per 1,000 hospital admissions. In-hospital mortality was 25 per cent. In-hospital mortality was 25 per cent. During the first month after admission, 45 per cent of the patients underwent surgery. 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. During the last three decades, valve replacement and even valve repair have become commonplace in the management of selected complications of NVE. 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. Valve surgery was associated with reduced mortality. Background 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) valve dysfunction leading to heart failure (1B) infection with difficult to treat pathogens (1C) 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) 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) persistent infection, including paravalvular abscess (1C) embolic events while on an appropriate antibiotic regimen OR associated with a large vegetation (2C) 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) 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 Retrospective Descriptive study January 2004 – December 2005 January 2004 – December 2005 23 NVE patients 23 NVE patients

8. Demographic data Age : year (mean) 39.4 Sex (male: female) 2 : 1 Comorbidity, risk factor DM : n% 4 (17.4) CKD : n% 1(4.3) HIV : n% 1(4.3) Liver cirrhosis ; n% 1(4.3) Marfan’s syndrome : n% 1(4.3)

9. Demographic data NYHA I : n% NYHA II : n% 5 (22) NYHA III : n% 6 (26) NYHA IV : n% 12 (52) Dyspnea status

10. Diagnostic tool Hemoculture positive : n% 5(21.7) echocardiogram Annular abscess : n% 11(48) Vegetation : n% 15(65.3) Interventricular abscess : n% 1(4.2)

11. organism S. Viridan : n%4(14.7) S. epidermidis :n%1(4.2)

12. operation Interval between diagnosis and surgery : hours (mean) 54.6 procedure MVR : n% 3(13) AVR : n% 18(78) Aortic root replacement : n% 1(4.2) MV repair : n% 1(4.2) CPB time : min(mean) 97 Aortic cross clamp time : min(mean) 53.4

13. outcome ICU stay : day (mean) 8.2 Hospital stay : day (mean) 27.3 Hospital mortality : n% 6(26) complication Heart failure : n% 15(65) Re-operation (bleeding) : n% 2(8.6) Complete heart block : n% 2(8.6) Acute renal failure : n% 4(17.2) Paravalvular leakage : n% 4(17.2)

14. summary NVE is not uncommon condition in srinagarind hospital. NVE is not uncommon condition in srinagarind hospital. Hospital mortality rate is still high. 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 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, operative mortality and morbidity, recurrent embolization, recurrent embolization, co-morbidities, co-morbidities, the long-term complications of valvular prostheses and anticoagulation. the long-term complications of valvular prostheses and anticoagulation.

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