Is simultaneous splenectomy an additive risk factor in surgical treatment for active endocarditis?

PURPOSE: Splenic abscess formation is a serious complication in the setting of active endocarditis, and splenectomy is recommended. However, the optimal timing for splenectomy is yet undetermined. The purpose of this study was to evaluate the role of a one-stage splenectomy and valve surgery for active endocarditis. METHODS: Among 202 consecutive endocarditis patients, 18 had splenic lesions on preoperative abdominal screening, who underwent cardiac surgery and splenectomy as a one-stage procedure (group A) and were compared to patients with unremarkable abdominal screening (group B, n = 184) undergoing sole cardiac surgery. RESULTS: No difference was observed regarding preoperative characteristics (age, gender, New York Heart Association [NYHA] grade, diabetes, coronary artery disease, redo surgery, adiposity, smoking), intubation time, and prolonged ventilation. There were 23 early postoperative deaths in group B (12.5%) vs. none in group A. At 180 days, survival was significantly higher for patients in group A (94.4%) vs. group B (67.9%, p = 0.016), although this difference did not reach statistical significance (log-rank test, p = 0.073). Multivariate Cox proportional hazards regression revealed age above 50 years (hazard ratio [HR] 3.327, 95% confidence interval [CI] 1.279-8.650) and NYHA class above III (NYHA III or IV: HR 3.117, 95% CI 1.119-8.683, p = 0.030; NYHA IV: HR 3.678, 95% CI 1.984-6.817, p < 0.001) as independent risk factors for mortality at 180 days. A trend towards a protective factor was observed for simultaneous splenectomy (HR = 0.171, 95% CI 0.023-1.255). CONCLUSION: Simultaneous valve surgery and splenectomy is an approach for active endocarditis complicated by splenic lesions with a low 180-day mortality. Despite the expected risk elevation by septic lesions and the additive trauma of a laparotomy, patients with simultaneous splenectomy had a favourable outcome regarding early mortality and mortality at 6 months.

Management of biventricular assist device implantation in patients with necrotic pancreatitis.

This report describes the management of biventricular assist device (BIVAD) implantation in a patient with necrotic pancreatitis. BIVADs provide mechanical support for ventricular ejection in the failing heart and have become an accepted treatment for end-stage heart failure. They also have proved to be a successful bridge to heart transplantation. As their popularity has grown, the number of patients with BIVADs presenting for noncardiac surgery is increasing. We report the successful management of an implanted extracorporeal BIVAD in a patient with end-stage heart failure and with pancreatic stents in a case of necrotic pancreatitis. Historical, physical, laboratory, and imaging data allowed conservative management leading to a favorable outcome.