Surgeons' re-operative valve replacement practices in patients with endocarditis due to drug use.

Int J Crit Illn Inj Sci

Director of Research and Special Projects, William Novick Global Cardiac Alliance, Memphis TN, USA.

Published: December 2021


Category Ranking

98%

Total Visits

921

Avg Visit Duration

2 minutes

Citations

20

Article Abstract

Background: This study discerns surgeons' attitudes and practices in the determination of heart valve replacement for patients with infectious endocarditis (IE) due to intravenous drug use (IVDU). We aimed to identify the factors contributing to surgeons' decision-making process for initial and recurrent surgical heart valves and the availability of institutional guidance.

Methods: An IRB-approved, anonymous mixed-methods, open survey instrument was designed and validated with 24 questions. A convenience sample of cardiothoracic surgeons in the United States and globally resulted in a total of 220 study participants with 176 completing every question on the survey.

Results: A cluster analysis revealed that although surgeons can be divided into subgroups based on their previous experience with valve replacements, these groups are not perfectly homogenous, and the number of identified clusters is dependent on technique used. Analysis of variance revealed the variables that most clearly divided the surgeons into subgroups were, in order of importance, years of practice, number of valve replacements, and geography.

Conclusions: Our analysis showed heterogeneity among cardiothoracic surgeons regarding how they make clinical decisions regarding re-operative valve replacement related to IE-IVDU. Therefore, an opportunity exists for interprofessional teams to develop comprehensive guidelines to decrease variability in surgical decision-making regarding valve replacement associated with IE-IVDU.

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8725807PMC
http://dx.doi.org/10.4103/IJCIIS.IJCIIS_195_20DOI Listing

Publication Analysis

Top Keywords

valve replacement
16
re-operative valve
8
cardiothoracic surgeons
8
valve replacements
8
valve
6
surgeons' re-operative
4
replacement
4
replacement practices
4
practices patients
4
patients endocarditis
4

Similar Publications

Introduction: Whilst aortic stenosis remains the most prevalent valvular abnormality, the management of asymptomatic severe aortic stenosis remains a clinical challenge. Recently, two randomised-controlled trials (RCTs) - EVOLVED (Early Intervention in Patients With Asymptomatic Severe Aortic Stenosis and Myocardial Fibrosis) and Early TAVR (Transcatheter Aortic-Valve Replacement for Asymptomatic Severe Aortic Stenosis) - have been published, alongside an extended follow-up from the AVATAR (Aortic Valve Replacement Versus Conservative Treatment in Asymptomatic Severe Aortic Stenosis) study.

Evidence Acquisition: In response, we conducted a systematic review of PubMed, Ovid, and Cochrane databases, identifying RCTs up to October 29, 2024, that compared early intervention with conventional management.

View Article and Find Full Text PDF

Objective: Valve selection in acute type A aortic dissection (ATAAD) requiring aortic root replacement is challenging given the clinical acuity, unknown patient preferences, risk of surgical bleeding, and limited life expectancy. We sought to identify long-term outcomes of mechanical versus bioprosthetic aortic root replacement in young patients with ATAAD.

Methods: Retrospective review of our institution's database of ATAAD was conducted to identify patients aged 65 years and younger who underwent mechanical Bentall (mech-Bentall) or bioprosthetic Bentall (bio-Bentall) for ATAAD from 2002 to 2022.

View Article and Find Full Text PDF

Objective: To compare the clinical outcomes of double-valve replacement (DVR) using bovine pericardial and porcine bioprostheses, using a nationwide administrative claims database.

Methods: Adult patients (age ≥40 years) who underwent bioprosthetic DVR between 2003 and 2018 were identified from the Korean National Health Insurance Service database. The outcomes of interest were all-cause mortality, cardiac mortality, and valve-related events, including the incidences of reoperation, endocarditis, systemic thromboembolism, and major bleeding.

View Article and Find Full Text PDF

Objectives: Left ventricular vortex dynamics play a crucial role in cardiac function but are significantly altered by mitral valve diseases or surgical interventions. Such hemodynamic changes may lead to maladaptive intracardiac vortices, potentially triggering pathways associated with progressive left ventricular remodeling and thrombosis. This study assessed left ventricular hemodynamics under both physiological and pathological conditions using a biohybrid in vitro platform, aiming to analyze the impact of these conditions on cardiac function.

View Article and Find Full Text PDF

Objectives: Loeys-Dietz syndrome comprises genetically discrete subtypes of varying clinical severity. This study integrates longitudinal Loeys-Dietz syndrome clinical outcomes after aortic root replacement with transcriptomic analysis of aortic smooth muscle cell dysregulation to investigate mechanisms governing this subtype-specific aortic vulnerability.

Methods: Single institutional experience with aortic root replacement for nondissected aneurysm in patients with Loeys-Dietz syndrome was reviewed for midterm survival and distal aortic events (subsequent aortic intervention, aneurysm, or dissection).

View Article and Find Full Text PDF