Infective Bacterial Endocarditis
(IBE)- Indications for CVT Surgical Management
Beyond
antibiotic therapy and supportive management, there are instances where
patients with IBE should have an urgent referral to our CVT surgical colleagues for
assessment for the utility of surgical intervention.
The American College of
Cardiology/American Heart Association developed guidelines (2006) on the
management of valvular heart disease, including the role for surgical
management in patients with native valve endocarditis. Surgical consultation
should be sought early if there are possible indications that require expert
opinion.
Current
indications for surgical management in patients with native valve endocarditis
include:
- Valvular dysfunction leading to severe heart failure
- Infection with organisms that are difficult to treat
- Valvular destruction leading to severe regurgitation, and altered hemodynamics (i.e. elevated LV end-diastolic and/or LAP)
- Persistent infection (i.e. peri-valvular abscess)
- Embolic events while on appropriate antibiotics OR embolic events associated with a large vegetation
NOTE: a
vegetation >10 mm (or 1 cm) is not sufficient to require surgery, if there
are no other indications
Interesting Read/Resource:
Circulation (2010): Impact of Early Surgery on Embolic Events in Patients with Infective Endocarditis
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