The decision to pursue surgery for treatment of IE and the timing of such surgery is complex and requires a multidisciplinary approach. Early surgery (during hospitalization and before completion of an antimicrobial course) is recommended for patients with any of the following:
Severe valvular dysfunction resulting in symptomatic heart failure
Left-sided IE caused by S. aureus, fungal infections, or other highly resistant organisms
Associated complications, such as annular or aortic abscess, destructive penetrating lesions, or heart block
Persistent bacteremia or fevers lasting longer than 5 to 7 days after onset of appropriate antimicrobial therapy
Early surgery is reasonable in patients with recurrent emboli and persistent valve vegetations despite 5 to 7 days of antibiotic therapy, and early surgery may be considered in the presence of a large (>10-mm) left-sided vegetation to prevent embolic events. When IE is associated with a pacemaker or defibrillator, the entire system (generator and leads) must be removed.
Comments
Post a Comment