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Huuskonen A, Kesävuori R, Raivio P. Outcomes after Surgery for Endocarditis among Intravenous Drug Users and Nonusers. Thorac Cardiovasc Surg 2023; 71:38-45. [PMID: 34176109 DOI: 10.1055/s-0041-1727231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND The optimal treatment strategy for intravenous drug users (IVDU) with infective endocarditis (IE) is controversial. We therefore sought to investigate outcomes among IVDUs after surgery for IE. METHODS We retrospectively reviewed all 192 consecutive patients who underwent an operation for IE between 2005 and 2016 in the Helsinki University Hospital. Forty-seven patients (24.5%) were IVDUs and 145 (75.5%) were non-IVDUs. Mortality and reinfection and reoperation rates were evaluated. RESULTS IVDUs were younger (29.9 vs. 63.8 years, p < 0.001) and had less cardiovascular risk factors and lower EuroSCORE II (4.3 vs. 7.3%, p < 0.001), but Staphylococcus aureus infection (66.0 vs. 23.4%, p < 0.001), tricuspid valve endocarditis (34.0 vs. 2.8%, p < 0.001), and liver disease (63.8 vs. 2.8%, p < 0.001) occurred more often in IVDUs than in non-IVDUs. Thirty-day mortality of IVDUs was 8.5% and that of non-IVDUs was 6.9% (p = 0.711). Survival of IVDUs at 5 years was 70.8 ± 7.4% and survival of non-IVDUs was 67.9 ± 4.7% (p = 0.678). Relative to an age- and sex-matched general population, IVDUs had 58.6 (95% confidence interval [CI]: 33.7-101.9; p < 0.001) and non-IVUD 4.4 (95% CI: 3.1-6.2; p < 0.001) standardized mortality ratio. IVDUs had a higher reinfection rate at 5 years (25.8 ± 7.7% vs. 3.0 ± 1.7%, p < 0.001) and a higher early reoperation rate than non-IVDUs (10.6 vs. 1.4%, p = 0.003). CONCLUSIONS IVDUs and non-IVDUs had comparable survival at 5 years, but IVDUs had a very significantly increased risk of death in comparison to an age- and sex-matched general population. IVDUs had higher reinfection and early reoperation rates. Survival was poor after medically treated reinfection.
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Affiliation(s)
- Antti Huuskonen
- Department of Cardiac Surgery, Heart and Lung Center, Helsinki University Hospital, Helsinki, HUS, Finland
| | - Risto Kesävuori
- Department of Cardiac Surgery, Heart and Lung Center, Helsinki University Hospital, Helsinki, HUS, Finland
| | - Peter Raivio
- Department of Cardiac Surgery, Heart and Lung Center, Helsinki University Hospital, Helsinki, HUS, Finland
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An KR, Luc JGY, Tam DY, Dagher O, Eikelboom R, Bierer J, Cartier A, Vo TX, Vaillancourt O, Forgie K, Elbatarny M, Gao SW, Whitlock R, Lamba W, Arora RC, Adams C, Yanagawa B. Infective Endocarditis Secondary to Injection Drug Use: A Survey of Canadian Cardiac Surgeons. Ann Thorac Surg 2021; 112:1460-1467. [PMID: 33358887 DOI: 10.1016/j.athoracsur.2020.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/10/2020] [Accepted: 12/02/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Injection drug use-associated infective endocarditis (IDU-IE) is a growing epidemic. The objective of this survey was to identify the beliefs and practice patterns of Canadian cardiac surgeons regarding surgical management of IDU-IE. METHODS A 30-question survey was developed by a working group and distributed to all practicing adult cardiac surgeons in Canada. Data were analyzed using descriptive statistics. RESULTS Of 146 surgeons, 94 completed the survey (64%). Half of surgeons (49%) would be less likely to operate on patients with IE if associated with IDU. In the case of prosthetic valve IE owing to continued IDU, 36% were willing to reoperate once and 14% were willing to reoperate twice or more. Most surgeons required commitments from patients before surgery (73%), and most referred patients to addiction services (81%). Some surgeons would offer a Ross procedure (10%) or homograft (8%) for aortic valve IE, and 47% would consider temporary mechanical circulatory support. Whereas only 17% of surgeons worked at an institution with an endocarditis team, 71% agreed that there was a need for one at each institution. Most surgeons supported the development of IDU-IE-specific guidelines (80%). CONCLUSIONS Practice patterns and surgical management of IDU-IE vary considerably across Canada. Areas of clinical unmet needs include the development of a formal addiction services referral protocol for patients, the development of an interdisciplinary endocarditis team, as well as the creation of IDU-IE clinical practice guidelines.
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Affiliation(s)
- Kevin R An
- Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, Canada
| | - Jessica G Y Luc
- Division of Cardiovascular Surgery, University of British Columbia, Vancouver, Canada
| | - Derrick Y Tam
- Division of Cardiovascular Surgery, University of British Columbia, Vancouver, Canada
| | - Olina Dagher
- Division of Cardiac Surgery, University of Calgary, Calgary, Canada
| | - Rachel Eikelboom
- Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Joel Bierer
- Division of Cardiac Surgery, Dalhousie University, Halifax, Canada
| | | | - Thin X Vo
- Division of Cardiac Surgery, University of Ottawa Heart Institute, University of Ottawa, Ottawa, Canada
| | | | - Keir Forgie
- Division of Cardiac Surgery, University of Alberta, Edmonton, Canada
| | - Malak Elbatarny
- Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, Canada
| | | | - Richard Whitlock
- Division of Cardiac Surgery, McMaster University, Hamilton, Canada
| | - Wiplove Lamba
- Division of Psychiatry, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Rakesh C Arora
- Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Corey Adams
- Division of Cardiac Surgery, University of Calgary, Calgary, Canada
| | - Bobby Yanagawa
- Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, Canada.
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Galloway AC. "Addiction Is a Fatal Disease Unless Treated": Where Do Cardiac Surgeons Stand in This Continuum? Ann Thorac Surg 2020; 110:499. [PMID: 31991137 DOI: 10.1016/j.athoracsur.2019.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 12/11/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Aubrey C Galloway
- Department of Cardiothoracic Surgery, New York University School of Medicine, 530 First Ave, Ste 9V, New York, NY 10016.
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