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Nappi F, Avtaar Singh SS, Jitendra V, Fiore A. Bridging Molecular and Clinical Sciences to Achieve the Best Treatment of Enterococcus faecalis Endocarditis. Microorganisms 2023; 11:2604. [PMID: 37894262 PMCID: PMC10609379 DOI: 10.3390/microorganisms11102604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/14/2023] [Accepted: 09/26/2023] [Indexed: 10/29/2023] Open
Abstract
Enterococcus faecalis (E. faecalis) is a commensal bacterium that causes various infections in surgical sites, the urinary tract, and blood. The bacterium is becoming a significant concern because it tends to affect the elderly population, which has a high prevalence of undiagnosed degenerative valvular disease and is often subjected to invasive procedures and implanted medical devices. The bacterium's actions are influenced by specific characteristics like pili activity and biofilm formation. This resistance significantly impedes the effectiveness of numerous antibiotic therapies, particularly in cases of endocarditis. While current guidelines recommend antimicrobial therapy, the emergence of resistant strains has introduced complexity in managing these patients, especially with the increasing use of transcatheter therapies for those who are not suitable for surgery. Presentations of the condition are often varied and associated with generalised symptoms, which may pose a diagnostic challenge. We share our encounter with a case study that concerns an octogenarian who had a TAVI valve and developed endocarditis. We also conducted a literature review to identify the essential treatment algorithms for such cases.
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Affiliation(s)
- Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord, 93200 Saint-Denis, France
| | | | - Vikram Jitendra
- Department of Cardiothoracic Surgery, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, UK;
| | - Antonio Fiore
- Department of Cardiac Surgery, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, 94000 Creteil, France;
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2
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Nappi F, Schoell T, Spadaccio C, Acar C, da Costa FDA. A Literature Review on the Use of Aortic Allografts in Modern Cardiac Surgery for the Treatment of Infective Endocarditis: Is There Clear Evidence or Is It Merely a Perception? Life (Basel) 2023; 13:1980. [PMID: 37895362 PMCID: PMC10608498 DOI: 10.3390/life13101980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/18/2023] [Accepted: 09/25/2023] [Indexed: 10/29/2023] Open
Abstract
Infective valve endocarditis is caused by different pathogens and 60% of those involve the aortic valve with valve failure. Although S. aureus is recognized as the most frequently isolated causative bacterium associated with IE in high-income countries, Gram-positive cocci nevertheless play a crucial role in promoting infection in relation to their adhesive matrix molecules. The presence of pili on the surface of Gram-positive bacteria such as in different strains of Enterococcus faecalis and Streptococcus spp., grants these causative pathogens a great offensive capacity due to the formation of biofilms and resistance to antibiotics. The indications and timing of surgery in endocarditis are debated as well as the choice of the ideal valve substitute to replace the diseased valve(s) when repair is not possible. We reviewed the literature and elaborated a systematic approach to endocarditis management based on clinical, microbiological, and anatomopathological variables known to affect postoperative outcomes with the aim to stratify the patients and orient decision making. From this review emerges significant findings on the risk of infection in the allograft used in patients with endocarditis and no endocarditis etiology suggesting that the use of allografts has proved safety and effectiveness in patients with both pathologies.
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Affiliation(s)
- Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord, 93200 Saint-Denis, France;
| | - Thibaut Schoell
- Department of Cardiac Surgery, Centre Cardiologique du Nord, 93200 Saint-Denis, France;
| | - Cristiano Spadaccio
- Cardiothoracic Surgery, Lancashire Cardiac Center, Blackpool Victoria Hospital, Blackpool FY3 8NP, UK;
| | - Christophe Acar
- Department of Cardiothoracic Surgery, Hôpital Pitié-Salpêtrière, Boulevard de Hôpital 47-83, 75013 Paris, France;
| | - Francisco Diniz Affonso da Costa
- Department of Cardiovascular Surgery, Instituto de Neurologia e Cardiologia de Curitiba—INC Cardio, Curitiba 81210-310, Parana, Brazil;
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Iaccarino A, Barbone A, Basciu A, Cuko E, Droandi G, Galbiati D, Romano G, Citterio E, Fumero A, Scarfò I, Manzo R, La Canna G, Torracca L. Surgical Challenges in Infective Endocarditis: State of the Art. J Clin Med 2023; 12:5891. [PMID: 37762834 PMCID: PMC10532218 DOI: 10.3390/jcm12185891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/24/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
Infective endocarditis (IE) is still a life-threatening disease with frequent lethal outcomes despite the profound changes in its clinical, microbiological, imaging, and therapeutic profiles. Nowadays, the scenario for IE has changed since rheumatic fever has declined, but on the other hand, multiple aspects, such as elderly populations, cardiovascular device implantation procedures, and better use of multiple imaging modalities and multidisciplinary care, have increased, leading to escalations in diagnosis. Since the ESC and AHA Guidelines have been released, specific aspects of diagnostic and therapeutic management have been clarified to provide better and faster diagnosis and prognosis. Surgical treatment is required in approximately half of patients with IE in order to avoid progressive heart failure, irreversible structural damage in the case of uncontrolled infection, and the prevention of embolism. The timing of surgery has been one of the main aspects discussed, identifying cases in which surgery needs to be performed on an emergency (within 24 h) or urgent (within 7 days) basis, irrespective of the duration of antibiotic treatment, or cases where surgery can be postponed to allow a brief period of antibiotic treatment under careful clinical and echocardiographic observation. Mainly, guidelines put emphasis on the importance of an endocarditis team in the handling of systemic complications and how they affect the timing of surgery and perioperative management. Neurological complications, acute renal failure, splenic or musculoskeletal manifestations, or infections determined by multiresistant microorganisms or fungi can affect long-term prognosis and survival. Not to be outdone, anatomical and surgical factors, such as the presence of native or prosthetic valve endocarditis, a repair strategy when feasible, anatomical extension and disruption in the case of an annular abscess (mitral valve annulus, aortic mitral curtain, aortic root, and annulus), and the choice of prosthesis and conduits, can be equally crucial. It can be hard for surgeons to maneuver between correct pre-operative planning and facing unexpected obstacles during intraoperative management. The aim of this review is to provide an overview and analysis of a broad spectrum of specific surgical scenarios and how their challenging management can be essential to ensure better outcomes and prognoses.
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Affiliation(s)
- Alessandra Iaccarino
- Cardiovascular Department, UO of Cardiac Surgery of IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (A.B.); (A.B.); (E.C.); (G.D.); (D.G.); (G.R.); (E.C.); (A.F.); (L.T.)
| | - Alessandro Barbone
- Cardiovascular Department, UO of Cardiac Surgery of IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (A.B.); (A.B.); (E.C.); (G.D.); (D.G.); (G.R.); (E.C.); (A.F.); (L.T.)
| | - Alessio Basciu
- Cardiovascular Department, UO of Cardiac Surgery of IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (A.B.); (A.B.); (E.C.); (G.D.); (D.G.); (G.R.); (E.C.); (A.F.); (L.T.)
| | - Enea Cuko
- Cardiovascular Department, UO of Cardiac Surgery of IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (A.B.); (A.B.); (E.C.); (G.D.); (D.G.); (G.R.); (E.C.); (A.F.); (L.T.)
| | - Ginevra Droandi
- Cardiovascular Department, UO of Cardiac Surgery of IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (A.B.); (A.B.); (E.C.); (G.D.); (D.G.); (G.R.); (E.C.); (A.F.); (L.T.)
| | - Denise Galbiati
- Cardiovascular Department, UO of Cardiac Surgery of IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (A.B.); (A.B.); (E.C.); (G.D.); (D.G.); (G.R.); (E.C.); (A.F.); (L.T.)
| | - Giorgio Romano
- Cardiovascular Department, UO of Cardiac Surgery of IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (A.B.); (A.B.); (E.C.); (G.D.); (D.G.); (G.R.); (E.C.); (A.F.); (L.T.)
| | - Enrico Citterio
- Cardiovascular Department, UO of Cardiac Surgery of IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (A.B.); (A.B.); (E.C.); (G.D.); (D.G.); (G.R.); (E.C.); (A.F.); (L.T.)
| | - Andrea Fumero
- Cardiovascular Department, UO of Cardiac Surgery of IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (A.B.); (A.B.); (E.C.); (G.D.); (D.G.); (G.R.); (E.C.); (A.F.); (L.T.)
| | - Iside Scarfò
- Cardiovascular Department, Applied Diagnostic Echocardiography of IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (I.S.); (R.M.); (G.L.C.)
| | - Rossella Manzo
- Cardiovascular Department, Applied Diagnostic Echocardiography of IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (I.S.); (R.M.); (G.L.C.)
| | - Giovanni La Canna
- Cardiovascular Department, Applied Diagnostic Echocardiography of IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (I.S.); (R.M.); (G.L.C.)
| | - Lucia Torracca
- Cardiovascular Department, UO of Cardiac Surgery of IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (A.B.); (A.B.); (E.C.); (G.D.); (D.G.); (G.R.); (E.C.); (A.F.); (L.T.)
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Nappi F, Avtaar Singh SS. Host-Bacterium Interaction Mechanisms in Staphylococcus aureus Endocarditis: A Systematic Review. Int J Mol Sci 2023; 24:11068. [PMID: 37446247 DOI: 10.3390/ijms241311068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/21/2023] [Accepted: 07/02/2023] [Indexed: 07/15/2023] Open
Abstract
Staphylococci sp. are the most commonly associated pathogens in infective endocarditis, especially within high-income nations. This along with the increasing burden of healthcare, aging populations, and the protracted infection courses, contribute to a significant challenge for healthcare systems. A systematic review was conducted using relevant search criteria from PubMed, Ovid's version of MEDLINE, and EMBASE, and data were tabulated from randomized controlled trials (RCT), observational cohort studies, meta-analysis, and basic research articles. The review was registered with the OSF register of systematic reviews and followed the PRISMA reporting guidelines. Thirty-five studies met the inclusion criteria and were included in the final systematic review. The role of Staphylococcus aureus and its interaction with the protective shield and host protection functions was identified and highlighted in several studies. The interaction between infective endocarditis pathogens, vascular endothelium, and blood constituents was also explored, giving rise to the potential use of antiplatelets as preventative and/or curative agents. Several factors allow Staphylococcus aureus infections to proliferate within the host with numerous promoting and perpetuating agents. The complex interaction with the hosts' innate immunity also potentiates its virulence. The goal of this study is to attain a better understanding on the molecular pathways involved in infective endocarditis supported by S. aureus and whether therapeutic avenues for the prevention and treatment of IE can be obtained. The use of antibiotic-treated allogeneic tissues have marked antibacterial action, thereby becoming the ideal substitute in native and prosthetic valvular infections. However, the development of effective vaccines against S. aureus still requires in-depth studies.
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Affiliation(s)
- Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord, 93200 Saint-Denis, France
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Nappi F, Nenna A, Spadaccio C, Avtaar Singh SS, Almazil A, Acar C. The Use of the Cryopreserved Aortic Homograft for Aortic Valve Replacement: Is It Still an Option? J Cardiovasc Dev Dis 2023; 10:248. [PMID: 37367413 DOI: 10.3390/jcdd10060248] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 05/28/2023] [Accepted: 06/06/2023] [Indexed: 06/28/2023] Open
Abstract
The indications for cryopreserved allografts in aortic valve replacement are still debatable. We aim to identify factors influencing early and long-term durability of the aortic homograft and to define subgroups of patients with an improved long-term quality of life, survival, and freedom from structural valve degeneration (SVD). We evaluated our series of 210 patients who underwent allograft implantation with a retrospective cohort study design over a period of 20 years. Endpoints were overall mortality, cardiac mortality related to SVD, the incidence of SVD, reoperation, and a composite endpoint comprising major adverse cardiac and cerebrovascular events (MACCEs), which includes cardiac death both related and not related to SVD, subsequent aortic valve surgery, new or recurrent infection of implanted allograft, recurrent aortic regurgitation, rehospitalization for heart failure, an increase in New York Heart Association (NYHA) class of ≥1, or cerebrovascular events. The primary indication for surgery was endocarditis (48%), which was also a predisposing factor for increased cardiac mortality. Overall mortality was 32.4% with a 27% incidence of SVD and mortality associated with SVD of 13.8%. Reoperation occurred in 33.8% and MACCEs in 54.8%. Long-term NYHA functional class and echocardiographic parameters improved over time. Statistical analysis demonstrated that root replacement technique and adult age were protective factors for SVD. We found no statistically significant difference in the clinical outcomes analyzed between women of childbearing age who had children after surgery and the rest of the women. The cryopreserved allograft is still a valid option in aortic valve replacement, providing acceptable durability and clinical outcomes with optimal hemodynamic performance. SVD is influenced by the implantation technique. Women of childbearing age might have additional benefits from this procedure.
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Affiliation(s)
- Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord, 93200 Saint Denis, France
| | - Antonio Nenna
- Department of Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Roma, Italy
| | - Cristiano Spadaccio
- Cardiothoracic Surgery, Lancashire Cardiac Center, Blackpool Victoria Hospital, Blackpool FY3 8NP, UK
| | | | - Almothana Almazil
- Department of Cardiac Surgery, Centre Cardiologique du Nord, 93200 Saint Denis, France
| | - Christophe Acar
- Department of Cardiothoracic Surgery, Hôpital Pitié-Salpêtrière, Boulevard de Hôpital 47-83, 75013 Paris, France
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Biomechanics of Pulmonary Autograft as Living Tissue: A Systematic Review. Bioengineering (Basel) 2022; 9:bioengineering9090456. [PMID: 36135002 PMCID: PMC9495771 DOI: 10.3390/bioengineering9090456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/01/2022] [Accepted: 09/04/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction: The choice of valve substitute for aortic valve surgery is tailored to the patient with specific indications and contraindications to consider. The use of an autologous pulmonary artery (PA) with a simultaneous homograft in the pulmonary position is called a Ross procedure. It permits somatic growth and the avoidance of lifelong anticoagulation. Concerns remain on the functionality of a pulmonary autograft in the aortic position when exposed to systemic pressure. Methods: A literature review was performed incorporating the following databases: Pub Med (1996 to present), Ovid Medline (1958 to present), and Ovid Embase (1982 to present), which was run on 1 January 2022 with the following targeted words: biomechanics of pulmonary autograft, biomechanics of Ross operation, aortic valve replacement and pulmonary autograph, aortic valve replacement and Ross procedure. To address the issues with heterogeneity, studies involving the pediatric cohort were also analyzed separately. The outcomes measured were early- and late-graft failure alongside mortality. Results: a total of 8468 patients were included based on 40 studies (7796 in pediatric cohort and young adult series and 672 in pediatric series). There was considerable experience accumulated by various institutions around the world. Late rates of biomechanical failure and mortality were low and comparable to the general population. The biomechanical properties of the PA were superior to other valve substitutes. Mathematical and finite element analysis studies have shown the potential stress-shielding effects of the PA root. Conclusion: The Ross procedure has excellent durability and longevity in clinical and biomechanical studies. The use of external reinforcements such as semi-resorbable scaffolds may further extend their longevity.
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Infective Endocarditis in High-Income Countries. Metabolites 2022; 12:metabo12080682. [PMID: 35893249 PMCID: PMC9329978 DOI: 10.3390/metabo12080682] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 01/27/2023] Open
Abstract
Infective endocarditis remains an illness that carries a significant burden to healthcare resources. In recent times, there has been a shift from Streptococcus sp. to Staphylococcus sp. as the primary organism of interest. This has significant consequences, given the virulence of Staphylococcus and its propensity to form a biofilm, rendering non-surgical therapy ineffective. In addition, antibiotic resistance has affected treatment of this organism. The cohorts at most risk for Staphylococcal endocarditis are elderly patients with multiple comorbidities. The innovation of transcatheter technologies alongside other cardiac interventions such as implantable devices has contributed to the increased risk attributable to this cohort. We examined the pathophysiology of infective endocarditis carefully. Inter alia, the determinants of Staphylococcus aureus virulence, interaction with host immunity, as well as the discovery and emergence of a potential vaccine, were investigated. Furthermore, the potential role of prophylactic antibiotics during dental procedures was also evaluated. As rates of transcatheter device implantation increase, endocarditis is expected to increase, especially in this high-risk group. A high level of suspicion is needed alongside early initiation of therapy and referral to the heart team to improve outcomes.
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The New Challenge for Heart Endocarditis: From Conventional Prosthesis to New Devices and Platforms for the Treatment of Structural Heart Disease. BIOMED RESEARCH INTERNATIONAL 2021; 2021:7302165. [PMID: 34222484 PMCID: PMC8219429 DOI: 10.1155/2021/7302165] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 06/02/2021] [Indexed: 01/07/2023]
Abstract
Infective endocarditis is a sinister condition with considerable morbidity and mortality. Its relevance in the current era is compounded by the increased use of implanted devices such as replacement valves or cardiac implantable electronic devices. These infections are caused by multiple different bacteria with different virulence, pathogenicity, and antimicrobial resistance. Unlike in native endocarditis, the presence of foreign tissue permits sustenance by inflammatory and thrombotic processes as the artificial surfaces promote inflammatory responses and hypercoagulability. Prevention of these infections has been suggested with the use of homografts in combination with antibiotics. Others have attempted to use "low fouling coats" with little clinical success thus far. The use of antibiotic prophylaxis plays a pivotal part in reducing the incidence of prosthesis-related endocarditis. This remains especially crucial with the increasing use of transcatheter heart valve therapies. The widespread use of cardiac implantable electronic devices such as permanent pacemakers, implantable cardioverter defibrillators, and cardiac resynchronization therapy devices has also heralded a noticeable increase in cases of infectious endocarditis affecting complex equipment which can be difficult to treat. Multimodality strategies are needed with input from surgeons and cardiologists to ensure treatment is both prompt and successful, tailored to the individual needs of the patients.
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Nappi F, Acar C. Monobloc or Separate Aortic and Mitral Homografts for Endocarditis of the Intervalvular fibrosa? Ann Thorac Surg 2021; 112:1382-1383. [PMID: 33539785 DOI: 10.1016/j.athoracsur.2020.10.086] [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: 10/18/2020] [Accepted: 10/24/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Francesco Nappi
- Cardiac Surgery Centre Cardiologique du Nord de Saint-Denis, 36 Rue des Moulins Gémeaux, 93200 Saint-Denis, France
| | - Christophe Acar
- Department of Cardiovascular Surgery, Hôpital de la Salpétrière, Paris, France
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Benedetto U, Spadaccio C, Gentile F, Moon MR, Nappi F. A narrative review of early surgery versus conventional treatment for infective endocarditis: do we have an answer? ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1626. [PMID: 33437825 PMCID: PMC7791236 DOI: 10.21037/atm-20-3880] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The most appropriate strategy and timing for surgery in infective endocarditis (IE) remains an argument of debate. Despite some authors promote the adoption of an early surgical approach (within 48 hours) to limit mortality and complications, no robust randomized trials are available on this argument and the evidence on this subject remain at the "expert opinion" level. Additionally, the different messages promulgated by the American and European guidelines contributed to fuel confusion regarding the relative priority of the surgical over medical therapy in IE. The European Society of Cardiology (ESC) guidelines individuates three level of urgency: emergency surgery, to be performed within 24 hours; urgent surgery, recommended within a few days; elective surgery to be performed after 1-2 weeks of antibiotic therapy. Urgent surgery is recommended for most cases of IE. In the American Heart Association (AHA)'s guidelines define early surgery as "during the initial hospitalization and before completion of a full course of antibiotics." Some of the available evidences showed that are no proven benefits in delaying surgery if a definite diagnosis of IE has been established. However, this argument is controversial across the literature and several factors including the center specific experience can play a role in decision-making. In this review the latest evidences on IE clinical and surgical characteristics along with the current studies on the adoption of an early surgical approach are analyzed to clarify whether enough evidence is available to inform an update of the guidelines.
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Affiliation(s)
- Umberto Benedetto
- Department of Cardiothoracic Surgery, Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Cristiano Spadaccio
- Department of Cardiac Surgery, Golden Jubilee National Hospital, Glasgow, UK.,Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK
| | | | - Marc R Moon
- Department of Cardiac Thoracic Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, Paris, France
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Benedetto U, Avtaar Singh SS, Spadaccio C, Moon MR, Nappi F. A narrative review of the interpretation of guidelines for the treatment of infective endocarditis. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1623. [PMID: 33437822 PMCID: PMC7791230 DOI: 10.21037/atm-20-3739] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The recommendations of the current guidelines and the position papers of professional societies from the European Society of Cardiology/European Society of Cardiothoracic Surgeons (ESC), the American College of Cardiology/American Heart Association/Society of Thoracic Surgeon (ACC/AHA/STS) and American Association of Thoracic Surgeon (AATS) regarding management of patients with valvular heart endocarditis were updated over the past decade. However, some of the recommendations appear to contradict one another. Given the changing paradigms on how the disease manifests, our aim was to review the respective guidelines and highlight these differences whilst drawing attention to the subsequent studies from which they were derived. In particular, concerns regarding antibiotic prophylaxis and therapy, imaging modality for diagnosis and follow-up, cerebrovascular sequalae and timing of surgery are appraised in detail. We also identified the novel techniques used such as transcatheter therapies and advances in imaging modalities used for diagnosis and treatment of this condition. The lack of randomised control trials (RCTs) does raise several issues regarding applicability of findings in day-to-day practice. Therefore, the focus of upcoming studies should be on clearly defined multicenter RCTs to provide more robust evidence for the management and treatment of infective endocarditis as future guidelines will be based on the outcomes of these trials.
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Affiliation(s)
- Umberto Benedetto
- Department of Cardiothoracic Surgery, Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Sanjeet Singh Avtaar Singh
- Department of Cardiac Surgery, Golden Jubilee National Hospital, Glasgow, UK.,Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK
| | - Cristiano Spadaccio
- Department of Cardiac Surgery, Golden Jubilee National Hospital, Glasgow, UK.,Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK
| | - Marc R Moon
- Department of Cardiac Thoracic Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, Paris, France
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Nappi F, Spadaccio C, Mihos C, Shaikhrezai K, Acar C, Moon MR. The quest for the optimal surgical management of tricuspid valve endocarditis in the current era: a narrative review. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1628. [PMID: 33437827 PMCID: PMC7791263 DOI: 10.21037/atm-20-4685] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Tricuspid valve endocarditis (TVE) is a growing concern with increasing rates and mortality burden. The currently changing etiology, the antibiotic resistance and the raise in iatrogenic causes as with implantable cardiac devices [cardiac implantable electronic device (CIED)], represent a challenge for the management of these patients. The progressively widespread use of CIEDs is adding to the more commonly known intravenous (IV) drug abuse in the list of causes. Treatment strategies include medical therapy alone or surgery. From the surgical standpoint tricuspid valve repair, replacement or the staged procedure of valvectomy as bridge to replacement are available options. Treatment of endocarditis related to implantable device is another expanding field which requires a coordinated action with microbiologists in consideration of the microorganism antibiotic resistance. This review summarizes the currently available evidences on TVE including surgical indications, timing of interventions and technical considerations. The conflicting results of the available observational evidences and the non-unanimous consensus on many aspects of TVE impede to reach a definitive conclusion regarding the best management strategy and demands for randomized studies in this field.
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Affiliation(s)
- Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, Paris, France
| | - Cristiano Spadaccio
- Department of Cardiac Surgery, Golden Jubilee National Hospital, Glasgow, UK.,Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Christos Mihos
- Echocardiography Laboratory, Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, FL, USA
| | - Kasra Shaikhrezai
- Department of Cardiac Surgery, Golden Jubilee National Hospital, Glasgow, UK
| | - Christophe Acar
- Department of Cardiovascular Surgery, Hospital de la Salpetriere, Paris, France
| | - Marc R Moon
- Department of Cardiac Thoracic Surgery, Washington University School of Medicine, Saint, Louis, Missouri, USA
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Pollari F, Spadaccio C, Cuomo M, Chello M, Nenna A, Fischlein T, Nappi F. Sharing of decision-making for infective endocarditis surgery: a narrative review of clinical and ethical implications. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1624. [PMID: 33437823 PMCID: PMC7791252 DOI: 10.21037/atm-20-4626] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Infective endocarditis (IE) is nowadays one of the most challenging disease in cardiac surgery because of its multifaceted clinical and anatomical presentation. Despite the many clinical and surgical advances achieved in the past 60 years, there is a lack of evidence regarding the ideal strategy. The present review aims to investigate and highlight two main novel concepts for the decision-making of the best substitute. Firstly, the concept of an "endocarditis team": a coordinated multidisciplinary effort in the diagnostic work-up, especially in conditions of high risk of embolization or clinical deterioration. A good "endocarditis team" has the role to overcome such problem, in order to ensure a prompt and balanced strategy. Secondly, which ethical considerations are required to drive the choice of valvular substitute. The choice of best valve substitute is a relevant issue of debate, not only with operative but also prognostic and accordingly ethical aftermaths. Many different solutions have been developed to substitute the infected valve. Among these: mechanical prosthesis (MP), biological stented prosthesis (BP), sutureless bioprosthesis and cryopreserved homografts (CHs). Patients need to be informed in detail about the technical issues pertaining the use of these valve substitute. We will discuss the evidences regarding the risk of recurrent infections or future potentially severe calcification of aortic homograft valve and wall (in other words, the failure of the homograft) and the difficulties in managing the reoperation.
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Affiliation(s)
- Francesco Pollari
- Department of Cardiac Surgery, Klinikum Nürnberg-Paracelsus Medical University, Nuremberg, Germany
| | - Cristiano Spadaccio
- Department of Cardiac Surgery, Golden Jubilee National Hospital, Glasgow, UK.,Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK
| | - Michela Cuomo
- Division of Pediatric Cardiac Surgery, University of Erlangen, Erlangen, Germany
| | - Massimo Chello
- Department of Cardiovascular Surgery, University Campus Bio-Medico of Rome, Rome, Italy
| | - Antonio Nenna
- Department of Cardiovascular Surgery, University Campus Bio-Medico of Rome, Rome, Italy
| | - Theodor Fischlein
- Department of Cardiac Surgery, Klinikum Nürnberg-Paracelsus Medical University, Nuremberg, Germany
| | - Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, Paris, France
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Nappi F, Spadaccio C, Moon MR. A management framework for left sided endocarditis: a narrative review. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1627. [PMID: 33437826 PMCID: PMC7791223 DOI: 10.21037/atm-20-4439] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Left sided endocarditis (LSE) can include the entirety or portion of mitral and/or aortic valve and the structures in their anatomical contiguity and represent a significant portion of emergency surgical activity. Literature and guidelines on the management of LSE relies mainly on observational studies given the difficulty in designing randomized trials in emergency settings. Heart teams (HT) are often called in to difficult decisions on the most appropriate strategy to adopted in case of LSE. Decision-making should take into account the localization and the extension of the infection, patient preoperative status and comorbidities, presence of a previous valve prosthesis and best timing for surgery. Despite evidence suggests that early surgery may improve survival in patients with complicated infective endocarditis (IE), an increased risk of recurrence and postoperative valvular dysfunctions has been reported. The most important factors associated with long-term outcomes are preoperative multiorgan failure, prosthetic mechanical valve IE, vegetation size ≥15 mm, and timing of surgical treatment. Importantly, up to one third of potential candidates do not undergo surgery and these patients experience extremely high mortality rates. Another important point regards the choice of the optimal valve substitute to be used according to the different clinical situation. The lack of RCT in this field and the difficulty to design this type of studies in the case of non-elective conditions further complicates the possibility to achieve a univocal consensus on the best strategy to be adopted in each form of LSE and further validation studies are needed. On the basis of the current evidences a decisional algorithm is proposed summarizing all the crucial aspects in the management of LSE.
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Affiliation(s)
- Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, Paris, France
| | - Cristiano Spadaccio
- Department of Cardiac Surgery, Golden Jubilee National Hospital, Glasgow, UK.,Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Marc R Moon
- Department of Cardiac Thoracic Surgery, Washington University School of Medicine, St Louis, Missouri, USA
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Nappi F, Avtaar Singh SS, Timofeeva I. Learning From Controversy: Contemporary Surgical Management of Aortic Valve Endocarditis. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2020; 14:1179546820960729. [PMID: 33088184 PMCID: PMC7545763 DOI: 10.1177/1179546820960729] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 08/30/2020] [Indexed: 12/27/2022]
Abstract
Aortic valve replacement is the commonest cardiac surgical operation performed worldwide for infective endocarditis (IE). Long-term durability and avoidance of infection relapse are goals of the procedure. However, no detailed guidelines on prosthesis selection and surgical strategies guided by the comprehensive evaluation of the extension of the infection and its microbiological characteristics, clinical profile of the patient, and risk of infection recurrence are currently available. Conventional mechanical or stented xenografts are the preferred choice for localized aortic infection. However, in cases of complex IE with the involvement of the root or the aortomitral continuity, the use of homograft is suggested according to the surgeon and center experience. Homograft use should be counterbalanced against the risk of structural degeneration. Prosthetic bioroot or prosthetic valved conduit (mechanical and bioprosthetic) are also potentially suitable alternatives. Further development of preservation techniques enabling longer durability of allogenic substitutes is required. We evaluate the current evidence for the use of valve substitutes in aortic valve endocarditis and propose an evidence-based algorithm to guide the choice of therapy. We performed a systemic review to clarify the contemporary surgical management of aortic valve endocarditis.
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Affiliation(s)
- Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, Paris, France
| | - Sanjeet Singh Avtaar Singh
- Department of Cardiac Surgery, Golden Jubilee National Hospital, Glasgow, UK
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Irina Timofeeva
- Department of Imaging, Centre Cardiologique du Nord de Saint-Denis, Paris, France
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Nappi F, Singh SSA, Spadaccio C, Acar C. Revisiting the guidelines and choice the ideal substitute for aortic valve endocarditis. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:952. [PMID: 32953752 PMCID: PMC7475423 DOI: 10.21037/atm-20-1522] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Aortic valve replacement is the most commonly performed cardiac surgical operation worldwide for infective endocarditis (IE). Long-term durability and avoidance of infection relapse are the treatment goals. However, no detailed guidelines on prosthesis selection and surgical strategy are available. Management should be guided by a comprehensive evaluation of infection extension and its microbiological characteristics, the clinical profile of the patient and the risk of infection recurrence. We conducted a literature search of the PubMed database, EMBASE and Cochrane Library (through November 2019) for studies reporting to the use of biological substitutes in aortic valve endocarditis (AVE). Studies comparing long-term outcomes in the use of allogenic and autologous with conventional prostheses were investigated. Conventional mechanical or stented xenografts are the preferred choice for localized aortic infection. In cases of complex IE with the involvement of the root or the aorto-mitral continuity, the use of homografts are recommended, according to surgeon's and center experience. Homograft use needs to be balanced against the risk of structural degeneration. Prosthetic bioroot or prosthetic valved conduit with a mechanical or bioprosthetic valve are acceptable alternatives. The choice of aortic valves substitute and surgical strategy in IE is multifaceted. Principles guiding the selection of prosthesis and surgical approach rely on the long-term durability and the avoidance of infection relapse. A decisional algorithm considering the extension of the infection and its microbiological characteristics, the clinical profile of the patient and the risk of infection recurrence is provided. A multidisciplinary effort is required to achieve consistent outcomes.
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Affiliation(s)
- Francesco Nappi
- Department of Cardiac Surgery, North Cardiological Center, Saint-Denis, Paris, France
| | - Sanjeet Singh Avtaar Singh
- Department of Cardiac Surgery, Golden Jubilee National Hospital, Glasgow, UK.,University of Glasgow Institute of Cardiovascular and Medical Sciences, Glasgow, UK
| | - Cristiano Spadaccio
- Department of Cardiac Surgery, Golden Jubilee National Hospital, Glasgow, UK.,University of Glasgow Institute of Cardiovascular and Medical Sciences, Glasgow, UK
| | - Christophe Acar
- Department of Cardiovascular Surgery, Heart Institute, la Pitie Salpetriere Hospital, Paris, France
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Nappi F, Spadaccio C, Chello M. Aortic homografts: Should we really lose the opportunity? J Thorac Cardiovasc Surg 2020; 157:e245-e246. [PMID: 31288368 DOI: 10.1016/j.jtcvs.2018.11.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 11/10/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, Paris, France
| | - Cristiano Spadaccio
- Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow, United Kingdom; University of Glasgow Institute of Cardiovascular and Medical Sciences, Glasgow, United Kingdom
| | - Massimo Chello
- Department of Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
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Abstract
The annual incidence of infective endocarditis (IE) is estimated to be between 15 and 80 cases per million persons in population-based studies. The incidence of IE is markedly increased in patients with valve prostheses (>4 per 1,000) or with prior IE (>10 per 1,000). The interaction between platelets, microorganisms and diseased valvular endothelium is the cause of vegetations and valvular or perivalvular tissue destruction. Owing to its complexity, the diagnosis of IE is facilitated by the use of the standardized Duke-Li classification, which combines two major criteria (microbiology and imaging) with five minor criteria. However, the sensitivity of the Duke-Li classification is suboptimal, particularly in prosthetic IE, and can be improved by the use of PET or radiolabelled leukocyte scintigraphy. Prolonged antibiotic therapy is mandatory. Indications for surgery during acute IE depend on the presence of haemodynamic, septic and embolic complications. The most urgent indications for surgery are related to heart failure. In the past decade, the prevention of IE has been reoriented, with indications for antibiotic prophylaxis now limited to patients at high risk of IE undergoing dental procedures. Guidelines now emphasize the importance of nonspecific oral and cutaneous hygiene in individual patients and during health-care procedures.
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Nappi F, Singh SSA, Lusini M, Nenna A, Gambardella I, Chello M. The use of allogenic and autologous tissue to treat aortic valve endocarditis. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:491. [PMID: 31700927 DOI: 10.21037/atm.2019.08.76] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The surgical treatment of aortic valve endocarditis (AVE) is generally performed using conventional mechanical or biological xenograft prosthesis, with limited use of aortic homograft (Ao-Homo) or pulmonary autograft (PA). Clinical evidence has demonstrated a clear contradiction between the proven benefits of Ao-Homo and PA in the context of infection and the very limited use of allogenic or autologous tissue in everyday clinical practice. This review aims to summarize the most recent and relevant literature in order to foster the scientific debate on the use of the use of allogenic and autologous tissue to treat AVE. The decisional process of the Heart Team should also include the preferences of the patient, his/her family, the general cardiologist or primary care physician. The use of allogenic or autologous valve substitute is beneficial if there is a high risk of recurrence of infection, avoiding extensive adhesiolysis and debridement of synthetic material. In any case, those procedures should be performed by highly trained centers to optimize outcomes.
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Affiliation(s)
- Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord, Saint-Denis, Paris, France
| | | | - Mario Lusini
- Department of Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Antonio Nenna
- Department of Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | | | - Massimo Chello
- Department of Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
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Xu A, Jin J, Li X, Xiao J, Zhu P, Gong W, Liu Y, Yu Y, Wang C, Zhang C, Hameed I, Salemi A, Hernandez-Vaquero D, Rajab TK, Nappi F, Shen J, Chen B. Mitral valve restenosis after closed mitral commissurotomy: case discussion. J Thorac Dis 2019; 11:3659-3671. [PMID: 31559074 DOI: 10.21037/jtd.2019.08.05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Anyi Xu
- Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai 318000, China
| | - Jiang Jin
- Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai 318000, China
| | - Xiaodong Li
- Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai 318000, China
| | - Jian Xiao
- Changzheng Hospital Affiliated to Shanghai Secondary Military Medical University, Shanghai 200000, China
| | - Peng Zhu
- South Hospital of Southern Medical University, Guangzhou 510000, China
| | - Wenhui Gong
- The First Affiliated Hospital of Anhui Medical University, Hefei 230031, China
| | - Yue Liu
- The First Affiliated Hospital of Harbin Medical University, Harbin 150000, China
| | - Yuetian Yu
- Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200000, China
| | | | - Chengxin Zhang
- First Affiliated Hospital of Anhui Medical University, Hefei 230000, China
| | - Irbaz Hameed
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Arash Salemi
- Department of Cardiothoracic Surgery, RWJ/Barnabas Health, Rutgers University, NJ, USA
| | | | | | - Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, Paris, France
| | - Jianfei Shen
- Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai 318000, China
| | - Baofu Chen
- Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai 318000, China
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Nappi F, Spadaccio C. Mitral valve endocarditis—Unrealized expectations for repair of mitral valve. J Thorac Cardiovasc Surg 2019; 158:e31-e32. [DOI: 10.1016/j.jtcvs.2019.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 01/14/2019] [Accepted: 02/01/2019] [Indexed: 01/02/2023]
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Simplest solutions are not always the cleverest: Can we stitch in an infected annulus? Should we rethink the current guidelines? J Thorac Cardiovasc Surg 2019; 154:1899-1900. [PMID: 29132883 DOI: 10.1016/j.jtcvs.2017.05.099] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 05/20/2017] [Accepted: 05/31/2017] [Indexed: 10/27/2022]
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Nappi F, Nenna A, Petitti T, Spadaccio C, Gambardella I, Lusini M, Chello M, Acar C. Long-term outcome of cryopreserved allograft for aortic valve replacement. J Thorac Cardiovasc Surg 2018; 156:1357-1365.e6. [PMID: 29759737 DOI: 10.1016/j.jtcvs.2018.04.040] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 02/12/2018] [Accepted: 04/02/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE The most efficient surgical approach to severe aortic valve disease in the young adult is still debated: cryopreserved aortic allograft offers excellent hemodynamic and avoid anticoagulation, but long-term durability is influenced by structural valve deterioration (SVD). This study aimed to describe long-term results of aortic allografts and to identify factors influencing long-term durability. METHODS From January 1993 to August 2010, 210 patients underwent aortic allograft replacement via the free-hand subcoronary implantation technique (N = 55) or root replacement with coronary reimplantation (N = 155). Clinic and echocardiographic follow-up was updated to April 2016. RESULTS Overall mortality and cardiac mortality occurred in 80 (38.1%) and 64 (30.5%) patients, respectively. Reoperation was required in 69 cases (32.8%), whereas SVD required reoperation in 57 cases (27.1%). No early endocarditis occurred, whereas late endocarditis occurred in 4 patients. The free-hand technique seems to be associated with improved left ventricular remodeling compared with the root-replacement technique, and smaller allograft size represents a predictor of reoperation independently on the surgical technique used. In the overall population, there were 44 women of childbearing age, and 37 patients remained pregnant during the follow-up of the study. No differences were found in the clinical outcomes among women who had children and who did not. CONCLUSIONS Cryopreserved allograft is a valid option, especially in complex infective endocarditis and in women of childbearing age. A careful choice of allograft size and implantation technique can reduce the risk of SVD.
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Affiliation(s)
- Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, Paris, France.
| | - Antonio Nenna
- Department of Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Tommasangelo Petitti
- Department of Public Health and Statistics, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Cristiano Spadaccio
- Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow, United Kingdom; University of Glasgow Institute of Cardiovascular and Medical Sciences, Glasgow, United Kingdom
| | - Ivancarmine Gambardella
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Mario Lusini
- Department of Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Massimo Chello
- Department of Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Christophe Acar
- Department of Cardiac Surgery, Hopital La Pitie Salpetriere, Paris, France
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Nappi F, Spadaccio C, Dreyfus J, Attias D, Acar C, Bando K. Mitral endocarditis: A new management framework. J Thorac Cardiovasc Surg 2018; 156:1486-1495.e4. [PMID: 29884490 DOI: 10.1016/j.jtcvs.2018.03.159] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 03/17/2018] [Accepted: 03/30/2018] [Indexed: 02/07/2023]
Affiliation(s)
- Francesco Nappi
- Cardiac Surgery Centre Cardiologique du Nord de Saint-Denis, Paris, France.
| | - Cristiano Spadaccio
- Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom; University of Glasgow Institute of Cardiovascular and Medical Sciences, Glasgow, United Kingdom
| | - Julien Dreyfus
- Cardiology department Centre Cardiologique du Nord de Saint-Denis, Paris, France
| | - David Attias
- Cardiology department Centre Cardiologique du Nord de Saint-Denis, Paris, France
| | - Christophe Acar
- Department of Cardiovascular Surgery, Hôpital de la Salpétrière, Paris, France
| | - Ko Bando
- Department of Cardiac Surgery, The Jikei University School of Medicine, Tokyo, Japan
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Hussain ST, Blackstone EH, Pettersson GB. Allografts remain a cornerstone of surgical treatment of invasive and destructive aortic valve infective endocarditis: Surgeon and technique do matter! J Thorac Cardiovasc Surg 2017; 154:1900-1901.e1. [DOI: 10.1016/j.jtcvs.2017.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 08/08/2017] [Indexed: 10/28/2022]
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Does type of prosthesis affect long-term outcomes after aortic valve replacement for infective endocarditis? How should we properly answer this question? J Thorac Cardiovasc Surg 2016; 153:829-830. [PMID: 27993368 DOI: 10.1016/j.jtcvs.2016.10.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 10/27/2016] [Indexed: 10/20/2022]
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