Infektiöse Endokarditis – wann operieren?

Abstract

Despite advances in antimicrobial therapy and the development of better diagnostic and surgical techniques as well as antibiotic prophylaxis recommendations, infective endocarditis is still associated with a considerable mortality.

The demographic change with an increase in older patients and the increase in antibiotic resistant organisms has changed the pattern of infective endocarditis.

Rapid diagnosis, effective treatment, and prompt recognition of complications are essential to good patient outcome.

Optimal outcome requires both medical and surgical expertise and can be achieved only by an intense cooperation of cardiologists, microbiologists and cardiovascular surgeons.

The indication and the optimal timing for surgical intervention are influenced by various factors. Decisions regarding surgical intervention in patients with infective endocarditis should be individualized.

Surgery is indicated in patients with congestive heart failure, evidence of perivalvular infection, persistent infection despite appropriate antibiotic therapy, infective endocarditis caused by aggressive antibiotic-resistant bacteria or fungi, echocardiographic evidence of vegetations (especially when located on the anterior mitral leaflet with size > 10mm), persistent vegetation after systemic embolization and increase in vegetation size despite appropriate antimicrobial therapy.

In these patients early surgical intervention is essential to improve outcome and avoid complications.

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