Transcript abc.ppt

CARDIAC SURGERY FOR INFECTIVE
ENDOCARDITIS IN INJECTING DRUG USERS
Pirjo-Riitta Salminen 1), Haakon Sjursen 2), Øystein Wendelbo 2), Rune Haaverstad 1)
Department of Heart Disease 1) and Department of Medicine 2)
Haukeland University Hospital, Bergen, Norway
[email protected]
STUDY OBJECTIVE
To examine outcome in patients with
injecting drug abuse treated with cardiac
surgery for infective endocarditis at
Haukeland University Hospital.
MATERIAL AND METHODS
Between 2001 and 2011 eighteen patients
with injecting drug abuse, mostly heroin,
underwent operative treatment for infective
endocarditis. Data were retrospectively
reviewed from hospital records.
RESULTS
Median age was 36 (24-46) years.
Transoesophageal echocardiography
identified left-sided vegetations in 16
patients, in two only pulmonic and tricuspid
valves were affected.
Blood cultures grew Staphylococcus aureus
(10), alpha- or beta-hemolytic streptococci
(3) or enterococci (3). Median length of
antibiotic treatment prior to surgery was 15
(4-77) days. Indications for surgery were
heart failure, embolization and failing
antibiotic treatment.
Primary operative procedures were mainly
replacements with bioprostheses.
Aortic valve vegetations
Pulmonary valve
endocarditis
Thirty days mortality after primary operation
was 5.6%. Most patients continued injecting
drug abuse after discharge. Two thirds of the
AV prosthetis endocardititis patients received opiate substitution
treatment. Eleven patients were readmitted
for recurrent endocarditis, median 11 (3-72)
months after primary surgery. Six patients
were reoperated, one even a third time.
Indications for reoperation were
embolization, failing antibiotic therapy and
paravalvular leakage. Redo procedures often
Tricuspid valve endocarditis included aortic root replacement. Five of
these six patients continued injecting drugs.
with pacemaker infection
Eleven patients were alive at the end of
study.
CONCLUSION
Cardiac surgery for infective endocarditis in injecting drug abusers is confronted by ethical
dilemmas. Patients are young and seriously sick, but they are not able to stop injecting. A majority
were readmitted with prosthesis endocarditis. Also after reoperation most patients continued
injecting drugs.