Aim . To assess the detection rate of infective endocarditis (IE) in postoperative period in patients with aortic stenosis (AS) and analyze the impact of late diagnosis on disease outcomes. Material and methods . A retrospective analysis of the register of 1764 patients with AS, formed on the basis of transthoracic echocardiographic (echo) tests in2009-2011, was performed. During the 8-year follow-up period, 679 patients were operated on; IE was diagnosed in 131 people. Patients were divided into subgroups depending on the valve morphology and the time of IE verification before or after surgery. IE, first detected in the postoperative period, was considered as latent IE. Results . Among patients with AS, the proportion of people with IE was only 3,7%, however, pathomorphological examination revealed IE signs in 19,3%. In 58,8% of cases, IE was detected for the first time in the postoperative period. In 66,2% of cases, latent IE was diagnosed in patients with congenital heart disease (CHD) — bicuspid aortic valve (BAV). In the group of patients with known IE before surgery, there were lower levels of hemoglobin, erythrocytes and a higher level of creatinine. According to the results of a histological examination, inactive IE was diagnosed in 28% of cases. In 26,5% of patients stage 3 activity IE was defined, among which latent course was recorded in 16%. Single-agent antibiotic therapy (ABT) was carried out in 40,5% of patients, dual-agent ABT — in 50,0%, triple-agent — in 9,5%. The median duration of ABT was 14 days (7 to 42). The eight-year survival rate for patients with IE was 91,2%. Of the 9 deaths, only 5 (56%) had a diagnosis of IE before surgery. Conclusion . More than half of the patients operated on for AV defects had a latent course of IE and, as a result, late diagnosis, which could affect medium-term survival. Most of the people with latent IE included in the analysis had CHD-BAV, which requires the development of IE preventive measures in this patient population. Various approaches to the ABT of latent IE in clinical practice determine the relevance of additional studies aimed at unification the ABT approaches in this clinical setting.
更多
分享
引用
