Navigation Links
Early Surgery May Benefit Some With Heart Infection
Date:6/27/2012

By Denise Mann
HealthDay Reporter

WEDNESDAY, June 27 (HealthDay News) -- People with an advanced form of a heart infection called endocarditis may do better if they undergo early surgery than if they are treated with antibiotics initially, a new study suggests.

Infective or bacterial endocarditis occurs when bacteria settles in the heart lining or heart valve. In advanced cases, the abnormal bacterial growth, often called vegetation, can be large enough to break off and travel elsewhere in the body, such as to the brain, where it may cause a stroke. Advanced infective endocarditis can also damage the heart valve.

People with existing heart disease or heart-valve problems are most likely to develop endocarditis.

In a new study published June 28 in the New England Journal of Medicine, researchers evaluated close to 80 people, average age 47, with advanced infective endocarditis.

Of these, 37 had early surgery within 48 hours of their diagnosis, and 39 received conventional therapy with antibiotics while they were monitored to see if the infection abated. Thirty people placed in the conventional treatment group eventually had surgery.

Early surgery reduced the risk of developing an embolism (or clot) and did not increase the risk of in-hospital death, the study showed.

After six months, the rate of adverse events, including death, repeat hospitalization for congestive heart failure or a recurrence of endocarditis, was 3 percent in the early-surgery group versus 28 percent in the conventionally treated patients.

"Early surgery can be the preferred option to further improve clinical outcomes of infective endocarditis, which is associated with considerable morbidity and mortality," said study author Dr. Duk-Hyun Kang, a cardiologist at University of Ulsan College of Medicine in Seoul, South Korea.

"If a patient with infective endocarditis has large vegetations and severe valve disease, we would advise them to request early referral to medical centers with adequate experience and resources for early surgery," Kang said.

Surgery for infective endocarditis aims to remove all infected tissue, repair the heart tissue and repair or replace the affected valve.

Others experts said only certain patients would warrant early surgery.

The new study "showed that patients with the combination of large vegetations and valve dysfunction, even if they are stable and not in heart failure, have a high risk of suffering serious embolic events or to progress to heart failure with need for emergency surgery and that early surgery prevented these complications," said Dr. Gosta Pettersson, co-author of an accompanying journal editorial and vice chair of thoracic and cardiovascular surgery at the Cleveland Clinic in Ohio.

Surgery does have its share of risks, however. "Historically, surgery for infective endocarditis was high-risk surgery, and the risk of recurrent infection on the replacement valve was also high," he said.

"Today, several publications have demonstrated that the added risk of operating on a patient with active infection has been more or less neutralized," Pettersson added.

Surgeons have become adept at removing all infected tissue and foreign material and determining how best to reconstruct the heart, he explained. "Taking care of this patient is a team work with close collaboration between infectious disease specialists, cardiologists and cardiac surgeons," he said. Importantly, he noted, "surgery is a complement to antibiotics not an alternative."

Not everyone with infective endocarditis should have surgery, Pettersson said. For example, the stable patient with small vegetations, preserved valve function and growth of bacteria sensitive to antibiotics does not need surgery. Severely ill patients who are unlikely to survive an operation or those who have irreversible brain damage from embolism would not be surgical candidates either, he pointed out.

Dr. Stephen Green, chief of cardiology at North Shore University Hospital in Manhasset, N.Y., said that the new findings only apply to a select few. "Patients in the study had very large vegetation and severe valve pathology," Green said. "These tend to be the worst of the worst."

Most people with infective endocarditis are treated with antibiotics. "We reserve surgery for people whose infections don't resolve, have fever or bacteria in the bloodstream or whose valves get destroyed," Green noted.

"Many people with milder forms can be treated with antibiotics and monitored long term to see if they need surgery," he added. This study suggests that "if you get a really bad clump of stuff on a valve, even if it's antibiotic-sensitive, maybe we should go to surgery earlier."

More information

Learn more about infective endocarditis at the American Heart Association.

SOURCES: Duk-Hyun Kang, M.D., cardiologist, University of Ulsan, Seoul, South Korea; Gosta Pettersson, M.D., Ph.D., vice chair, thoracic and cardiovascular surgery, and surgical director of lung transplantation, Cleveland Clinic, Ohio; Stephen Green, M.D., chief of cardiology, North Shore University Hospital, Manhasset, N.Y.; June 28, 2012, New England Journal of Medicine


'/>"/>
Copyright©2012 ScoutNews,LLC.
All rights reserved  

Related medicine news :

1. New Stool Test Might Aid in Early Detection of Colon Cancer
2. An Early Start for Your Child with Autism
3. Early Study Finds Some Promise for Lung Cancer Vaccine
4. Treat Rheumatoid Arthritis Early and Aggressively: Guidelines
5. JCI early table of contents for April 9, 2012
6. Eye Tremors May Aid Early Diagnosis of Parkinsons: Study
7. Nearly 1 in 4 grandparents store prescription medicines where children can easily find them
8. First contact: Early intervention key in diagnosis and treatment of serious mental illness
9. Brain Tumor Vaccine Shows Promise in Early Trial
10. Role of Screening, Monitoring in Early Kidney Disease Unclear
11. Detecting malaria early to save lives: New optical technique promises rapid and accurate diagnosis
Post Your Comments:
*Name:
*Comment:
*Email:
Related Image:
Early Surgery May Benefit Some With Heart Infection
(Date:12/8/2016)... ... 08, 2016 , ... Premier Fitness Camp (PFC) and The Chopra Center for ... and wellness program, at their world headquarters of Omni La Costa Resort & Spa ... to anyone seeking weight loss, personal development, a healthy lifestyle, or mental and physical ...
(Date:12/8/2016)... ... 2016 , ... STATEN ISLAND, N.Y., Nov. 24, 2016 — ... highest standards of trauma, maternity, cancer and chronic obstructive pulmonary disease (COPD) services ... Daniel Messina. , Among the recognitions, the American College of Surgeons' (ACS) named ...
(Date:12/8/2016)... , ... December 08, 2016 , ... ... the Affordable Care Act. Dr. Botelho advocates for the mass media launching of ... gives people ongoing opportunities to share their unfortunate experiences; such a movement can ...
(Date:12/8/2016)... ... 08, 2016 , ... The Dan Carlisle Agency, an Alabama-owned ... is announcing the launch of a charity drive to raise support and awareness ... and children in Birmingham has grown steadily since the 1980’s, and the Pathways ...
(Date:12/8/2016)... Payne, AL (PRWEB) , ... December 08, 2016 ... ... offering insurance and financial consulting services to residential and commercial clients in the ... awareness and support for Nobis Works. , Since 1977, Nobis Works has built ...
Breaking Medicine News(10 mins):
(Date:12/8/2016)... INDIANAPOLIS , Dec. 8, 2016  Eli Lilly ... detailed results of its phase 3 EXPEDITION3 trial at ... (CTAD) meeting. As previously disclosed, solanezumab did not meet ... study of solanezumab initiated in people with mild dementia ... pursue regulatory submissions for solanezumab for the treatment of ...
(Date:12/8/2016)... CITY , Dec. 8, 2016 ... US patents for improving the accuracy, reproducibility and ... images in long and small bone orthopaedic applications. ... approach to creating personalized orthopaedic restorations based on ... personalized orthopaedic restorations, the company harnesses the world,s ...
(Date:12/8/2016)... , Dec. 8, 2016  EIP Pharma, LLC ... obtained proof-of-mechanism for neflamapimod (previously code named VX-745), ... 2a clinical trials that demonstrated significant Alzheimer,s disease ... (12-week treatment) and Study 303 (6-week treatment) are ... in Alzheimer,s Disease (CTAD) scientific conference in ...
Breaking Medicine Technology: