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Friday July 13th, 2012

Endocarditis on cardiac devices requires valvular surgery

Dr. Josep Maria Miró

The Journal of the American Medical Association (JAMA) published two recent papers which show that, to improve prognosis in infections related to implantable cardiac devices, it is necessary to explant the whole infected system. The studies were conducted using data from month of 4,000 consecutive episodes of infective endocarditis bathered by the International Collaborative Endocarditis (ICE) Consortium. Dr. Josep Maria Miró, a researcher from IDIBAPS – Hospital Clínic, is part of its committee and one of the authors of both articles.

The ICE consortium was created in 2000 comprising 60 hospitals in the five continents. Between 2000 and 2006, the consortium collected over 4,000 episodes which have resulted in numerous publications on epidemiology, clinical features and prognosis of this serious infectious disease. The new work makes recommendations on the management of heart failure and analyzes when these patients may benefit from heart surgery motivated by valvular heart failure induced by an infectious endocarditis.

The first article deals with the time of onset of surgical treatment in these patients. The second one shows that, when removal of the infected system is not possible, there is a higher mortality rate per year. According to the results cardiac surgery for valve replacement is mandatory to reduce mortality in patients with heart failure, while it is not beneficial in those without. The consortium continues its investigations, especially in microbiological and echocardiographic issues.

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