Prosthetic valve endocarditis: early outcome following medical or surgical treatment

Prosthetic valve endocarditis [PVE] is an important cause of morbidity and mortality associated with heart valve replacement surgery. The aim of the present study was to describe the early outcome of treatment in patients with PVE in a single center. The data of all the episodes of PVE registered at our institution between 2002 and 2007 were collected and analyzed retrospectively. The patients were assessed using clinical criteria defined by Durack and colleagues [Duke criteria]. The analysis included a detailed study of hospital records. The continuous variables were expressed as mean +/- standard deviation, and the discrete variables were presented as percentages. Thirteen patients with PVE were diagnosed and treated at our center during the study period. In all the cases, mechanical prostheses were utilized. The patients' mean age was 46.9 +/- 12.8 years. Women made up 53.8% of all the cases. Early PVE was detected in 6 [46.2%] patients, and late PVE occurred in 7 [53.8%]. Eleven [84.6%] patients were treated with intravenous antimicrobial therapy, and the other two [15.4%] required surgical removal and replacement of the infected prosthesis in addition to antibiotic therapy. Blood cultures became positive in 46.2% of the patients. Mortality rate was 15.4% [2 patients]. It seems that in selected cases with PVE, i.e. in those who remain clinically stable and respond well to antimicrobial therapy, a cure could be achieved by antimicrobial treatment alone with acceptable morbidity and mortality risk

Impact of Dialysis on Open Cardiac Surgery

Dialysis patients frequently have coronary artery disease but are regarded as high risk patients for coronary artery bypass grafting [CABG]. Between February 2002 and September 2006, seventeen dialysis-dependent patients underwent isolated CABG at our center. CABG was performed under cardiopulmonary bypass [CPB] for all the patients. All cases had been maintained on hemodialysis and the duration of preoperative hemodialysis ranged from 6 to 24 months [mean 13.4 +/- 6.4]. The patients' characteristics, clinical and operative data as well as preoperative and mid-term outcome were reviewed. All patients were men with a mean age of 53 +/- 8.4 years. Mean preoperative ejection fraction was 45.5% +/- 10.4% [range 25 to 60%]. One internal mammary graft was used in 16 [94.1%] patients. Cardiopulmonary bypass and aortic cross-clamp times were 71.3 +/- 18.7 and 40.5 +/- 8.3 minutes respectively. The more frequent complication was prolonged mechanical ventilation in 2 [11.7%], there was no preoperative mortality. In mid-term follow-up [mean time: 11.8 +/- 9.5 months] the mid-term mortality rate was 20% [3 patients]. CABG in chronic renal dialysis patients can be accomplished with acceptable short and mid-term morbidity and mortality