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

ve 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 wo
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