Infection

Question 1

Incidence of prosthetic valve endocarditis (PVE)

Answer 1

0.5-1% per year post op

Question 2

Most common organisms implicated on early PVE (6-12 months post op)

Answer 2

a. Staph epi
b. staph aureus
c. strep viridans
d. gram neg rods
e. fungi

Question 3

Indications for immediate reop

Answer 3

• Periprosthetic leak
• Conduction abnormality
• annular abscess
• intracardiac fistula

Of note, it is acceptable to treat patients with only leaflet vegetationswith 6 weeks of intravenous antibiotics in an attempt to eradicate the infection and to sterilize the surgical field.

Question 4

Most common bacteria that cause Native valve infective endocarditis (NVE)

Answer 4

Strep viridans (28%)

Question 5

Initial treatment for Native valve infective endocarditis

Answer 5

IV penicillin + gentamicin (6 weeks)

Question 6

Indication for surgery for Native valve endocarditis

Answer 6

a. Peri-annular abscess
b. heart block
c. fungal infection
d. vegetation > 10 mm (any dimension)
e. persistently positive blood cultures
f. recurrent embolization despite treatment
g. congestive heart failure

Question 7

Which valve should be used for IVDU endocarditis?

Answer 7

Bioprosthetic valve

Question 8

Congenital Aortic valve pathology at risk for endocarditis?

Answer 8

Bicuspid aortic valve

Question 9

Prosthetic valve endocarditis (PVE) prevalence

Answer 9

up to 20% of all endocarditis cases

Question 10

Pathogen causing Prosthetic valve endocarditis (PVE) within the first year (Early)

Answer 10

Most commonly staph species

Question 11

Pathogen causing Prosthetic valve endocarditis (PVE) after the first year (Late)

Answer 11

Strep species

Question 12

Concept of antibiotic therapy for Prosthetic valve endocarditis (PVE)

Answer 12

1) using bactericidal antibiotics
2) using 2 drugs that have synergistic bactericidal efficacy
3) in vitrosusceptibility testing to ensure bactericidal levels
4) duration of antibiotic therapy of at least 6-8 weeks.

Question 13

Indication for surgery for Prosthetic valve endocarditis (PVE)

Answer 13

Failure of medical management:
refractory or progressive congestive heart failure
persistent sepsis or relapse of infection
prosthetic valve dysfunction
instability of the prosthesis
new cardiac conduction system abnormality
recurrent embolism is evidence of uncontrolled infection

Certain infectious organisms (fungus, gram-negative bacteria, staph aureus) often cannot be controlled by nonoperative measures, and early reoperation is advised