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ACTIVE ENDOCARDITIS:
SINGLE INSTITUTE
EXPERIENCE
HUNG DUNG VAN, THANH BINH PHAM, PHAN NGUYEN
HO CHI MINH HEART INSTITUTE


BACKGROUND
 Endocarditis in native or prosthetic valve
 Endocarditis in congenital patients
 Treatment : combined

+ medical
+ surgical : who, when and how
+ transplantation
Active endocarditis : still infection of a native or
prosthetic heart valve, the endocardial surface,
or an indwelling cardiac device
VAN H DUNG-HNPTTMLN 2016-HCM


DESIGN OF STUDY
 Retrospective study
 All infective endocarditis patients who were

operated from 1995 to 2015 at HoChiMinh
Heart Institute.
 Focus on 75 pts who were operated in 2day-2
weeks from admission

VAN H DUNG-HNPTTMLN 2016-HCM

Diagnosis and Treatment of Infective Endocarditis
Guideline 2014 AHA/ACC


Echocardiography
Echocardiographic findings in
IE
 Vegetation
 Abscess
 Pseudoaneurysm
 Perforation
 Fistula
 Valve aneurysm
 Dishence of prosthetic valve
VAN H DUNG-HNPTTMLN 2016-HCM


PATIENT DISTRIBUTION (N=671)
Treatment Type

N

%

Medical treatment

355

53

Surgical treatment : stable IE
active IE

241
75

36
11

VAN H DUNG-HNPTTMLN 2016-HCM


Pathogen of IE
Pathogens

N (%)

- Staphylococus aureus

10 (21.7)

- Streptococci spp.

25 (54.3)

- Enterococci spp.

4 (8.7)

- Candida albican

2 (4.3)

- Others

5 (10.8)

Hemoculture (+) = 46/75 (61.3%)
VAN H DUNG-HNPTTMLN 2016-HCM


Patients demographic
 Male/female

 Mean age
 Vegetation
 Annular abscess

: 97.3% ( echo : 100%)
: 26 : aortic : 19 (3 native)
mitral : 6
pulmonic : 1

VAN H DUNG-HNPTTMLN 2016-HCM


Classification by pathology
Pathology

N

Position
Aortic

Mitral

Congenital

18

3

Acquired Val.

30

16

14

Native Val.

05

4

1

Prosthetic Val.

20

16

4

Permanent
Electrode

2

VAN H DUNG-HNPTTMLN 2016-HCM

Pulmonic

Others

2

13


VAN H DUNG-HNPTTMLN 2016-HCM


VAN H DUNG-HNPTTMLN 2016-HCM

VAN H DUNG-HNPTTMLN 2016-HCM


Surgical Procedure
 Defect Repair







: 18
Valvuloplasty
: 16
Rescontruction by pericardium and valve
replace
: 32
Bentall
:4
Electrode remove + tricuspid plasty : 2
CABG associated : 2

VAN H DUNG-HNPTTMLN 2016-HCM


Mortality and

Redo

 Operative mortality : 6 (8%) ( 3 cerebral

hemorrhage , 2 MOF and 1 LCO ).
 Redo in first 3 months : 12
+ Ring dehiscense
:3
+ Valve prosthesis desinsertion : 9 .
( 5 cases IE relapse multiple  modified Bentall
– 3 death).

VAN H DUNG-HNPTTMLN 2016-HCM


Follow up
 Median time of FU : 9 years ( range from 3

months to 19 years)
 Late death : 5 ( 4 LCO and 1 sudden death )
 Late IE recur ( > 1 y) : 5 ( 4 redo and 2 death)

VAN H DUNG-HNPTTMLN 2016-HCM


Discusion
 Surgical Indication ( guideline of STS 2011))
 Timing of surgery ( guideline of ESC 2015)

VAN H DUNG-HNPTTMLN 2016-HCM

VAN H DUNG-HNPTTMLN 2016-HCM


Conclusion
 Surgical Indication should be based on clinical
manifestation + IE ’ s nature
 Early surgery in some condition like annular

abscess, uncontrol HF, uncontrol infection,
big vegetation…
 Our study showed that the result of early
surgery for active endocarditis is good in
intermediate and long-term FU.
VAN H DUNG-HNPTTMLN 2016-HCM


TRÂN TRỌNG CÁM ƠN
VAN H DUNG-HNPTTMLN 2016-HCM