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Zheng X, Liu F, Ma Q, Li J, Ma H. Rothia dentocariosa endocarditis with brain abscess and splenic abscess: case report and brief review. Front Cardiovasc Med 2024; 11:1370736. [PMID: 38966752 PMCID: PMC11222609 DOI: 10.3389/fcvm.2024.1370736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 06/10/2024] [Indexed: 07/06/2024] Open
Abstract
Rothia dentocariosa is a conditionally pathogenic bacterium that may cause infective endocarditis (IE) in selected patients and give rise to a variety of clinical complications, albeit it is not a common IE pathogen. We present the case of a patient diagnosed with Rothia dentocariosa-associated IE secondary to influenza B and thrombocytopenic purpura. The blood culture revealed Rochebacterium caries, cardiac ultrasound detected vegetation, while brain and spleen abscesses manifested and progressively deteriorated. Despite a suboptimal response to anti-infective therapy, the patient ultimately underwent aortic valve replacement. Discharge from the hospital was achieved upon control of the brain abscess and spleen abscess.
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Affiliation(s)
- Xue Zheng
- Clinical Pharmacy, Binzhou Medical University Affiliated Zibo Central Hospital, Zibo, Shandong, China
| | - Fang Liu
- Clinical Pharmacy, Shengli Oilfield Central Hospital, Dongying, Shandong, China
| | - Qiaoli Ma
- Department of Cardiology, Binzhou Medical University Affiliated Zibo Central Hospital, Zibo, Shandong, China
| | - Jing Li
- Clinical Pharmacy, Binzhou Medical University Affiliated Zibo Central Hospital, Zibo, Shandong, China
| | - Huiping Ma
- Clinical Pharmacy, Binzhou Medical University Affiliated Zibo Central Hospital, Zibo, Shandong, China
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Rajashekar P, Gupta A, Velayoudam D. Choice of valve substitutes. Indian J Thorac Cardiovasc Surg 2024; 40:78-82. [PMID: 38827545 PMCID: PMC11139820 DOI: 10.1007/s12055-024-01733-6] [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: 10/20/2023] [Revised: 03/21/2024] [Accepted: 03/26/2024] [Indexed: 06/04/2024] Open
Abstract
Infective endocarditis often necessitates surgical intervention, and the choice of valve substitute remains a topic of controversy and highly debatable due to the wide range of available options and recent technical advancements. This manuscript reviews the different valve substitutes in the context of infective endocarditis, including mechanical and bioprosthetic valves, homografts, xenografts, and tissue-engineered valves. The patient's age, sex, demographic location, intellectual quotient, comorbidities, available options, and the experience of the surgeon should all be taken into consideration while choosing the best valve substitute for that individual. While valve repair and reconstruction are preferred whenever feasible, valve replacement may be the only option in certain cases. The choice between mechanical and bioprosthetic valves should be guided by standard criteria such as age, sex, expected lifespan, associated comorbidities, and anticipated adherence to anticoagulation therapy and accessibility of medical facilities for follow-up. For patients with severe chronic illness or a history of intracranial bleeding or associated hematological disorders, the use of mechanical prostheses may be avoided. Homografts and bioprosthetic valves provide an alternative to mechanical valves, thereby decreasing the necessity for lifelong anticoagulation after surgery and diminishing the likelihood of bleeding complications. The manuscript also discusses specific valve substitutes for different heart valves (aortic, mitral, pulmonary, tricuspid positions) and highlights emerging techniques such as the aortic valve neocuspidization (Ozaki procedure) and tissue-engineered valves. Ultimately, the ideal valve substitute in IE should be evidence based on a comprehensive elucidation of clinical condition of the patient and available options.
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Affiliation(s)
- Palleti Rajashekar
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, CVTS Office 7th Floor, Cardiothoracic and Neurosciences Centre, Ansari Nagar, New Delhi, 110029 India
| | - Anish Gupta
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand India
| | - Devagourou Velayoudam
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, CVTS Office 7th Floor, Cardiothoracic and Neurosciences Centre, Ansari Nagar, New Delhi, 110029 India
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Hogan KJ, Sylvester CB, Wall MJ, Rosengart TK, Coselli JS, Moon MR, Chatterjee S, Ghanta RK. Outcomes after bioprosthetic versus mechanical mitral valve replacement for infective endocarditis in the United States. JTCVS OPEN 2024; 17:74-83. [PMID: 38420540 PMCID: PMC10897669 DOI: 10.1016/j.xjon.2023.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 11/14/2023] [Accepted: 11/28/2023] [Indexed: 03/02/2024]
Abstract
Objective In patients who underwent mitral valve replacement for infectious endocarditis, we evaluated the association of prosthesis choice with readmission rates and causes (the primary outcomes), as well as with in-hospital mortality, cost, and length of stay (the secondary outcomes). Methods Patients with infectious endocarditis who underwent isolated mitral valve replacement from January 2016 to December 2018 were identified in the United States Nationwide Readmissions Database and stratified by valve type. Propensity score matching was used to compare adjusted outcomes. Results A weighted total of 4206 patients with infectious endocarditis underwent bioprosthetic mitral valve replacement (n = 3132) and mechanical mitral valve replacement (n = 1074) during the study period. Patients in the bioprosthetic mitral valve replacement group were older than those in the mechanical mitral valve replacement group (median 57 vs 46 y, P < .001). After propensity matching, the bioprosthetic mitral valve replacement group (n = 1068) had similar in-hospital mortality, length of stay, and costs compared with the mechanical mitral valve replacement group (n = 1056). Overall, 90-day readmission rates were high (28.9%) and comparable for bioprosthetic mitral valve replacement (30.5%) and mechanical mitral valve replacement (27.5%, P = .4). Likewise, there was no difference in readmissions over a calendar year by prosthesis type. Readmissions for infection and bleeding were common for both bioprosthetic mitral valve replacement and mechanical mitral valve replacement groups. Conclusions Outcomes and readmission rates were similar for mechanical mitral valve replacement and bioprosthetic mitral valve replacement in infectious endocarditis, suggesting that valve choice should not be determined by endocarditis status. Additionally, strategies to mitigate readmission for infection and bleeding are needed for both groups.
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Affiliation(s)
- Katie J. Hogan
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
- Medical Scientist Training Program, Baylor College of Medicine, Houston, Tex
- Department of Bioengineering, Rice University, Houston, Tex
| | - Christopher B. Sylvester
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
- Medical Scientist Training Program, Baylor College of Medicine, Houston, Tex
| | - Matthew J. Wall
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Todd K. Rosengart
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
- Department of Cardiovascular Surgery, The Texas Heart Institute, Houston, Tex
| | - Joseph S. Coselli
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
- Department of Cardiovascular Surgery, The Texas Heart Institute, Houston, Tex
| | - Marc R. Moon
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
- Department of Cardiovascular Surgery, The Texas Heart Institute, Houston, Tex
| | - Subhasis Chatterjee
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
- Department of Cardiovascular Surgery, The Texas Heart Institute, Houston, Tex
| | - Ravi K. Ghanta
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
- Department of Cardiovascular Surgery, The Texas Heart Institute, Houston, Tex
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Delgado V, Ajmone Marsan N, de Waha S, Bonaros N, Brida M, Burri H, Caselli S, Doenst T, Ederhy S, Erba PA, Foldager D, Fosbøl EL, Kovac J, Mestres CA, Miller OI, Miro JM, Pazdernik M, Pizzi MN, Quintana E, Rasmussen TB, Ristić AD, Rodés-Cabau J, Sionis A, Zühlke LJ, Borger MA. 2023 ESC Guidelines for the management of endocarditis. Eur Heart J 2023; 44:3948-4042. [PMID: 37622656 DOI: 10.1093/eurheartj/ehad193] [Citation(s) in RCA: 186] [Impact Index Per Article: 186.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
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Fernández-Cisneros A, Andreu A, Hernández-Meneses M, Llopis J, Sandoval E, Pereda D, Alcocer J, Castellá M, Miró JM, Quintana E. Does Quality of Life in Survivors of Surgery for Acute Left-Sided Infective Endocarditis Differ from Non-Endocarditis Patients? Microorganisms 2023; 11:microorganisms11041058. [PMID: 37110481 PMCID: PMC10142739 DOI: 10.3390/microorganisms11041058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
Surgery for left-sided infective endocarditis (IE) has been demonstrated to improve patients' survival rates but information about quality of life (QoL) after surgery is scarce. The aim of this study was to assess the postoperative outcomes and QoL after surgery for IE patients compared to patients undergoing cardiac surgery for non-IE indications. Adult patients with definite acute left-sided IE were matched 1:1 to patients who underwent cardiac surgery for non-endocarditic purposes from 2014 to 2019. QoL was assessed using the SF-36 survey at the last follow-up. A total of 105 patients were matched. The IE group had higher rates of preoperative stroke (21% vs. 7.6%, p = 0.005) and higher stages of NYHA class (p < 0.001), EuroSCORE II (12.3 vs. 3.0, p < 0.001) and blood cell count abnormalities (p < 0.001). The IE group had higher incidence of low cardiac output syndrome (13.3% vs. 4.8%, p = 0.029), dialysis (10.5% vs 1.0%, p = 0.007) and prolonged mechanical ventilation (16.2% vs. 2.9%, p = 0.002) after surgery. At the last follow-up, subcomponents of the SF-36 QoL survey were not different between the groups. Patients who underwent cardiac surgery for IE demonstrated a higher risk profile with a higher rate of postoperative complications. Once recovered from the acute phase of the disease, the reported QoL at follow-up was comparable to that of matched cardiac patients operated for non-IE purposes.
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Affiliation(s)
| | - Aida Andreu
- Cardiovascular Surgery Department, Hospital Clinic-IDIBAPS, University of Barcelona, 08036 Barcelona, Spain
| | - Marta Hernández-Meneses
- Infectious Diseases Department, Hospital Clinic-IDIBAPS, University of Barcelona, 08036 Barcelona, Spain
| | - Jaume Llopis
- Department of Genetics, Microbiology and Statistics, Faculty of Biology, University of Barcelona, 08036 Barcelona, Spain
| | - Elena Sandoval
- Cardiovascular Surgery Department, Hospital Clinic-IDIBAPS, University of Barcelona, 08036 Barcelona, Spain
| | - Daniel Pereda
- Cardiovascular Surgery Department, Hospital Clinic-IDIBAPS, University of Barcelona, 08036 Barcelona, Spain
| | - Jorge Alcocer
- Cardiovascular Surgery Department, Hospital Clinic-IDIBAPS, University of Barcelona, 08036 Barcelona, Spain
| | - Manuel Castellá
- Cardiovascular Surgery Department, Hospital Clinic-IDIBAPS, University of Barcelona, 08036 Barcelona, Spain
| | - Jose M Miró
- Infectious Diseases Department, Hospital Clinic-IDIBAPS, University of Barcelona, 08036 Barcelona, Spain
- CIBERINFEC, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Eduard Quintana
- Cardiovascular Surgery Department, Hospital Clinic-IDIBAPS, University of Barcelona, 08036 Barcelona, Spain
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Abstract
The management of infective endocarditis is complex and inherently requires multidisciplinary cooperation. About half of all patients diagnosed with infective endocarditis will meet the criteria to undergo cardiac surgery, which regularly takes place in urgent or emergency settings. The pathophysiology and clinical presentation of infective endocarditis make it a unique disorder within cardiac surgery that warrants a thorough understanding of specific characteristics in the perioperative period. This includes, among others, echocardiography, coagulation, bleeding management, or treatment of organ dysfunction. In this narrative review article, the authors summarize the current knowledge on infective endocarditis relevant for the clinical anesthesiologist in perioperative management of respective patients. Furthermore, the authors advocate for the anesthesiologist to become a structural member of the endocarditis team.
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Formica F, Maestri F, Gripshi F, Gallingani A, Grossi S, Nicolini F. Long-Term Outcome of Mechanical and Biological Prostheses in Patients with Left-Side Infective Endocarditis: A Systematic Review and Meta-Analysis. J Clin Med 2021; 10:jcm10194356. [PMID: 34640374 PMCID: PMC8509294 DOI: 10.3390/jcm10194356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 11/16/2022] Open
Abstract
Background. Long-term outcomes of patients with infective endocarditis (IE) who received either a mechanical (MP) or biological prosthesis (BP) are conflicting. A meta-analysis of observational studies comparing the long-term outcomes of left-side IE with the use of MP versus BP was performed. Methods. Electronic databases from January 2000 to June 2021 were screened. Studies reporting long-term mortality were analyzed. The primary endpoint was long-term overall mortality. Secondary endpoints were in-hospital/.30-day mortality and freedom from both prosthesis reinfection and reintervention. The pooled hazard ratio (HR) with 95% confidence interval (CI) was calculated for survival according to the random effect model. Results. Thirteen retrospective observational studies reporting on 8645 patients (MP: 4688; BP: 4137) were included for comparison. Twelve studies reported data of long-term survival for a total of 8285 patients (MP: 4517; BP: 3768). The pooled analysis revealed that the use of MP was statistically associated with longer benefits compared to BP (HR 0.74; 95% CI 0.63–0.86; p < 0.0001). The median follow-up time ranged from 1 to 15.3 years. The pooled analysis of five studies reporting data on prosthesis reinfection in 4491 patients (MP: 2433; BP: 2058) did not reveal significant differences (HR 0.60; 95% CI 0.30–1.21; p = 0.15). Five studies reported data on prosthesis reintervention in 4401 patients (MP: 2307; BP: 2094). The meta-analysis revealed a significant difference in favor of MP (HR 0.40; 95% CI 0.29–0.55; p < 0.0001). Meta-regression reported no effect of male gender (p = 0.09) and age (p = 0.77) on long-term survival. Conclusions. In a meta-analysis of retrospective observational studies comparing the long-term outcome of patients who underwent surgery for left-sided IE, the use of MP compared to BP is associated with a significant longer-term survival and with a reduced incidence of late reoperation. The incidence of late reinfection is comparable between the two prostheses.
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Affiliation(s)
- Francesco Formica
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
- Cardiac Surgery Unit, University Hospital of Parma, 43126 Parma, Italy; (F.M.); (F.G.); (A.G.)
- Correspondence: (F.F.); (F.N.)
| | - Francesco Maestri
- Cardiac Surgery Unit, University Hospital of Parma, 43126 Parma, Italy; (F.M.); (F.G.); (A.G.)
| | - Florida Gripshi
- Cardiac Surgery Unit, University Hospital of Parma, 43126 Parma, Italy; (F.M.); (F.G.); (A.G.)
| | - Alan Gallingani
- Cardiac Surgery Unit, University Hospital of Parma, 43126 Parma, Italy; (F.M.); (F.G.); (A.G.)
| | - Silvia Grossi
- Department of Anesthesia and Intensive Care, Parma University Hospital, 43126 Parma, Italy;
| | - Francesco Nicolini
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
- Cardiac Surgery Unit, University Hospital of Parma, 43126 Parma, Italy; (F.M.); (F.G.); (A.G.)
- Correspondence: (F.F.); (F.N.)
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Raja Shariff RE, Ibrahim KS, Kasim S. Rapid Progression of Bioprosthetic Aortic Valve Endocarditis: From Paraprosthetic Abscesses into Tricuspid Valve Infiltration. PROCEEDINGS OF SINGAPORE HEALTHCARE 2021. [DOI: 10.1177/20101058211040861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We present a case of prosthetic valve endocarditis (PVE) in a 49-year-old gentleman with a history of bioprosthetic valve replacement following infective endocarditis of the aortic valve. He was pyrexial on arrival and electrocardiogram showed complete heart block. Transthoracic echocardiography and transoesophageal echocardiography revealed evidence of multiple echogenic, hypodensities within the paraprosthetic regions of the aortic bioprosthetic valve, suggestive of paravalvular abscesses, and infiltration into the right ventricle via the septal leaflet of the tricuspid valve. Early PVE is often nosocomial and ultimate management include radical debridement and major reconstruction with an expectedly high risk for mortality and post-operative complications.
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Affiliation(s)
| | | | - Sazzli Kasim
- Universiti Teknologi MARA (UITM) Sungai Buloh, Sungai Buloh, Malaysia
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Marin-Cuartas M, Davierwala PM. Reply to Tourmousoglou. Eur J Cardiothorac Surg 2021; 60:206. [PMID: 33501932 DOI: 10.1093/ejcts/ezab011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 12/20/2020] [Indexed: 11/15/2022] Open
Affiliation(s)
- Mateo Marin-Cuartas
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Piroze M Davierwala
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
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Valve-related factors and incidence of prosthetic valve endocarditis. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2021; 17:178-182. [PMID: 33552180 PMCID: PMC7848622 DOI: 10.5114/kitp.2020.102341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 10/24/2020] [Indexed: 11/17/2022]
Abstract
Aim The aim of the study was to present our experience and evaluate the valve-related factors and the incidence of prosthetic valve endocarditis. Material and methods This is a retrospective study. Between 2010 and 2018, 36 patients were re-operated on due to prosthetic valve endocarditis The valve-related factors (type, size and position of the prosthetic valve) were analysed. Results Thirty-six patients had prosthetic valve endocarditis. The overall hospital mortality was 16.67%. Early vs. late onset prosthetic valve endocarditis mortality was 23.08% vs. 13.04% respectively. The type, size or position of the prosthesis was not associated with prosthetic valve endocarditis. There was a statistically significant difference between occurrence of prosthetic infection between mitral repair and replacement both in mechanical and biological valve groups. The most common infective agent in the early onset group was Staphylococcus aureus, whereas in the late onset group it was Enterococcus faecalis. Out of 13 patients with early prosthetic valve endocarditis, 11 had infection in the perioperative period around primary operation. Conclusions Based on our experience, prosthetic valve endocarditis has a high mortality. Early onset prosthetic valve endocarditis is less common but has higher mortality compared to the late onset. Mitral valve repair was less prone to develop prosthetic valve endocarditis, and valve-related factors (type and size of the valve, valve position) did not have any influence on the incidence of prosthetic valve endocarditis.
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Wojnarski CM, Downey PS. Commentary: Aortic root endocarditis and coronary reimplantation. JTCVS Tech 2020; 4:70-71. [PMID: 34317967 PMCID: PMC8304493 DOI: 10.1016/j.xjtc.2020.08.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 08/13/2020] [Accepted: 08/14/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Charles M Wojnarski
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Duke University, Durham, NC
| | - Peter S Downey
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Duke University, Durham, NC
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Should the Ross Procedure Be Considered in Infective Aortic Valve Endocarditis? Ann Thorac Surg 2020; 110:861-862. [PMID: 32199824 DOI: 10.1016/j.athoracsur.2020.02.022] [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: 01/29/2020] [Accepted: 02/09/2020] [Indexed: 11/21/2022]
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Grant JK, Braghiroli J. Valve-in-valve transcatheter aortic valve replacement for degenerative prosthetic valve endocarditis. J Card Surg 2020; 35:967-968. [PMID: 32163612 DOI: 10.1111/jocs.14491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Jelani K Grant
- Internal Medicine Division, University of Miami, Jackson Memorial Hospital, Miami, Florida
| | - Joao Braghiroli
- Cardiovascular Division, Jackson Memorial Hospital, Miami, Florida
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