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Right-sided infective endocarditis: Insights into the forgotten valve

2019; Elsevier BV; Volume: 293; Linguagem: Inglês

10.1016/j.ijcard.2019.06.006

1874-1754

Bobby Yanagawa, Corey Adams, Richard Whitlock, Rakesh C. Arora,

Cardiac pacing and defibrillation studies

There is a rising trend in incidence of infective endocarditis [ [1] Pant S. Patel N.J. Deshmukh A. Golwala H. Patel N. Badheka A. et al. Trends in infective endocarditis incidence, microbiology, and valve replacement in the United States from 2000 to 2011. J. Am. Coll. Cardiol. 2015; 65: 2070-2076 Crossref PubMed Scopus (312) Google Scholar , [2] van den Brink F.S. Swaans M.J. Hoogendijk M.G. Alipour A. Kelder J.C. Jaarsma W. et al. Increased incidence of infective endocarditis after the 2009 European Society of Cardiology guideline update: a nationwide study in the Netherlands. Eur. Heart J. Qual. Care Clin. Outcomes. 2017; 3: 141-147 PubMed Google Scholar ]. The injection drug use (IDU) epidemic and the aging population with associated use of intracardiac implantable electronic devices are contributing factors. The 2007 American Heart Association, 2008 National Institute for Health and Clinical Excellence (UK) and 2009 European Society of Cardiology restricted the antibiotic prophylaxis guidelines to high-risk patients and to certain invasive procedures. This may also have had an impact, although there is conflicting data to support this notion [ [1] Pant S. Patel N.J. Deshmukh A. Golwala H. Patel N. Badheka A. et al. Trends in infective endocarditis incidence, microbiology, and valve replacement in the United States from 2000 to 2011. J. Am. Coll. Cardiol. 2015; 65: 2070-2076 Crossref PubMed Scopus (312) Google Scholar , [3] Garg P, Ko DT, Bray Jenkyn KM, Li L, Shariff SZ. Infective endocarditis hospitalizations and antibiotic prophylaxis rates before and after the 2007 American Heart Association guidelines revision. Circulation 2019 (Epub ahead of print). Google Scholar ]. Compared with left-sided IE, there is relatively little data on surgery for right-sided IE with few clinical practice guidelines (Table 1) [ [4] Baddour L.M. Wilson W.R. Bayer A.S. Fowler Jr., V.G. Tleyjeh I.M. Rybak M.J. et al. Infective endocarditis in adults: diagnosis, antimicrobial therapy, and management of complications: a scientific statement for healthcare professionals from the American Heart Association. Circulation. 2015; 132: 1435-1486 Crossref PubMed Scopus (1282) Google Scholar , [5] Habib G. Lancellotti P. Antunes M.J. Bongiorni M.G. Casalta J.P. Del Zotti F. et al. 2015 ESC guidelines for the management of infective endocarditis: the Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur. Heart J. 2015; 36: 3075-3128 Crossref PubMed Scopus (2240) Google Scholar ]. Table 1Guidelines for surgery on right-sided infective endocarditis. 2015 AHA Guidelines Infective Endocarditis in Adults AHA (2015) 2015 ESC Guidelines for the management of infective endocarditis Surgery for patients with complications(Class IIa; LOE C) Surgery for right heart failure and severe tricuspid regurgitation(Class IIa, LOE C) Valve repair over replacement(Class I; LOE C) Surgery for fastidious organisms or bacteraemia >7 days(Class IIa, LOE C) Individualized choice of valve prosthesis(Class IIa; LOE C) Surgery for vegetations >20 mm and recurrent pulmonary emboli(Class IIa, LOE C) Avoid surgery when possible in IDU patients(Class IIa; LOE C) AHA, American Heart Association; ESC, European Society of Cardiology; IE, infective endocarditis; IDU, injection drug use; LOE, level of evidence. Open table in a new tab AHA, American Heart Association; ESC, European Society of Cardiology; IE, infective endocarditis; IDU, injection drug use; LOE, level of evidence.