Infective endocarditis surgery

Overview

Infective endocarditis, occurs when fungi or bacteria enter the bloodstream and target heart valve tissue, typically following invasive procedures like dental work or endoscopy. While normal heart valve tissue is naturally resistant to infection, diseased valves exhibit vulnerabilities that increase the likelihood of infections. People with severe heart valve infections often require infective endocarditis surgery, which involves various procedures to clear away bacteria and fungi and repair damaged heart valves. For the majority of individuals, surgery remains the primary option for preventing heart failure and other life-threatening complications.

Reasons for undergoing the procedure

The timing of the medical procedure depends on the severity of your condition. In up to 30% of patients, it is advisable to undergo surgery shortly after being diagnosed. This is particularly important for individuals with replacement valves that have become infected.

There are other valve-related issues that may necessitate urgent surgery, including:

• The presence of abscesses or aneurysms around the aortic valve.
• Certain fungal infections that have caused extensive damage to the valve.
• Heart failure resulting from valve problems related to infective endocarditis.
• The presence of large vegetations on the valve that are at risk of breaking loose.
• Rupture of the chordae in the mitral valve, which are the structures connecting muscles to the tips of the valve flaps (leaflets).
• Mitral valve stenosis, a condition where the mitral valve narrows.
• Valvular regurgitation or a leaky valve, which occurs when heart valves do not close properly.

Additional factors to consider for urgent surgery include complications such as:

• Antibiotic resistance.
• Acute heart failure or cardiogenic shock.
• Infections caused by bacteria and fungi that are difficult to treat.
• Complications like blood clots (emboli) that occur after antibiotic therapy.
• Sepsis, a severe and systemic infection.
• Pulmonary edema, characterized by fluid accumulation in the lungs.

Risk

The following are potential risks of infective endocarditis surgery:

• Bleeding.
• Formation of blood clots.
• Stroke or cerebral hemorrhage.
• Irregular heart rhythms (Arrhythmia).
• Infection affecting the newly implanted heart valve.

Before the procedure

Healthcare providers treat endocarditis according with accepted guidelines. In addition, numerous tests are used by healthcare providers to decide if a patient needs surgery. They also assist surgeons in planning the surgery and assessing its success.

The following assessment includes:

• Physical examination: To evaluate the risk of complications, healthcare provider conduct medical history and physical examination.
• Blood test: Tests employing blood serology to identify the specific type of fungus or bacteria causing infective endocarditis.
• Imaging test: Computerized tomography (CT) scans to check for endocarditis-related problems.
• Transesophageal echocardiogram (TEE) and transthoracic echocardiogram (TTE): This procedure is to identify vegetations and evaluate heart valve damage.

During the procedure

The appropriate course of action for addressing heart valve damage depends on the type and severity of the condition.

Surgical options may include:

• Debridement, which involves the removal of infected tissue.
• Valve repair procedures, such as mitral chordae repair, which involve reattaching chord-like structures connecting muscles to valve flaps.
• Valve reconstruction to mend a diseased heart valve, possibly using pericardial tissue (the sac around the heart) to restore a damaged tricuspid valve.
• In severe cases of heart valve damage, replacement with an artificial valve may be necessary. For instance, if there is an abscess around the aortic valve, it may be necessary to replace a portion of the aorta as well.

After the procedure

During the initial phase of your recovery, you can anticipate a stay in the intensive care unit for a few days, followed by a transfer to a regular hospital floor. Throughout the early stages, healthcare providers will maintain continuous monitoring of your heart to detect any potential complications. It may be necessary to continue taking antibiotics, either orally or intravenously, for several weeks post-surgery to ensure the complete elimination of any remaining infection. Once you return home, it’s important to prioritize rest and take it easy. It’s natural to experience fatigue and discomfort during this period. Keep in mind that if you were severely ill before your procedure, your recovery may require a longer timeframe.

Outcome

Successful recovery after surgery is not guaranteed, and in some cases, vegetations may reoccur following treatment. Complications can lead to ongoing health issues for certain patients.

The prognosis is more favorable for individuals who undergo surgery before experiencing valve tissue damage and other complications. Conversely, those who develop heart failure tend to have a less promising prognosis.

Following surgery for infective endocarditis, it is essential to contact your healthcare provider if you experience any of the following symptoms:

• Chest fullness or pain, which may indicate pericardial effusion.
• Abnormal bleeding or oozing from the incision site.
• Redness, warmth, or swelling in the vicinity of the incision.
• Severe bruising.
• Signs of infection, such as fever or chills.
• Difficulty breathing or sensations of a racing or pounding heart (palpitations).