Effect of Antibiotic Therapy on the Sensitivity of Etiological Diagnostic Methods in Patients with Infective Endocarditis after Surgery

Aim. Assessment of impact  of the duration  of preoperative  antimicrobial  therapy  (AMT) on the sensitivity  of microbiological examination and polymerase  chain reaction (PCR) of blood/tissues of resected valves in operated patients with infective endocarditis  (IE).Materials and methods. 52 operated patients with active IE were included prospectively (Duke criteria, 2015). All patients underwent microbiological examination of blood  before  admission  to the cardiac  surgery  hospital,  as well as parallel  simultaneous microbiological examination and  PCR  of blood/tissues of excised  valves,  followed  by Sanger  sequencing. The duration  of preoperative  treatment  was  calculated  from the first day of AMT according to IE diagnosis to the day of surgery.Results. The causative agent of IE was established in 84.6% (n=44) patients by means of complex etiological diagnosis. A significant  decrease in the sensitivity of microbiological examination of venous blood was revealed when performed  in the period before and after hospitalization to a surgical hospital (up 44.2% to 17.3%, p<0.05). When comparing microbiological examination of blood/tissues of resected valves and PCR of blood/tissues of resected valves, molecular biological  methods demonstrated the greatest sensitivity, with a great advantage when examining the tissues of resected valves (17.3% and 19.2% vs. 38.5% and 75.0%, respectively;  p<0.001). The microbiological examination of venous blood performed  at an early date before admission  to the cardiac  surgery  hospital was comparable in sensitivity to the PCR blood test performed  at a later date after prolonged AMT,  and significantly less sensitive in relation to the PCR of resected valve tissues [44.2% and 38.5% (p>0.05) vs. 75.0% (p<0.05)]. In course of AMT 1-28 days,  there were comparable results of microbiological examination with PCR blood examination and significantly better results of PCR of resected valve tissues [31.0% and 34.5% and 41.4% (p>0.05) vs 72.4% (p<0.001), respectively], and with AMT ≥ 29 days, microbiological examination of any biological  material was negative  in all patients,  and PCR of blood/tissues of resected valves retained high sensitivity (0% and 0% vs. 34.8% and 78.3%, respectively; p<0.01).Conclusion. Long-term preoperative AMT significantly reduced the sensitivity of microbiological examination of resected valve blood/tissue in operated patients with IE, whereas PCR of resected valve blood/tissue was highly sensitive even with preoperative AMT for more than 29 days

Протезирование аортального клапана у больных пожилого и старческого возраста: анализ предоперационных факторов риска

Background. Despite an increase in the number of surgeries performed in elderly patients, conventional aortic valve replacement is associated with high postoperative mortality in comparison to young adults. The risk of surgical intervention in elderly patients is associated not only with the age, but also with the presence of a large number of concomitant diseases.Aim. To evaluate the immediate results of conventional aortic valve replacement and assess the impact of preoperative risk factors on surgical treatment.Methods. A retrospective analysis of the results of aortic valve replacement was performed in patients older than 65 years operated in the period from 2011 to 2015 (a total of 253 cases). The mean age of the patients was 70.4±4.14 years. The mean EuroSCORE was 6.09±4.45%. The impact of more than 30 preoperative risk factors on the in-hospital mortality and development of postoperative complications has been analyzed.Results. The overall in-hospital mortality was 10.3%. In-hospital mortality of isolated aortic valve replacement was 4.8%. In-hospital mortality of aortic valve replacement combined with coronary artery bypass grafting was 8.8%. High postoperative mortality rate was reliably associated with the urgency of surgery, a positive history of stroke, obesity, chronic renal failure, chronic obstructive pulmonary disease, pulmonary hypertension, a positive history of malignant neoplasms, polyvascular disease, pre-operative atrial fibrillation, IV class NYHA, post-stenotic aortic dilation, severe calcification, small aortic root.Conclusion. Aortic valve replacement in elderly and advanced age patients have relatively similar results to those of the younger patients. High risk of surgery in advanced age patients is mainly associated with the presence of concomitant extracardiac pathology and preoperative risk factors.Актуальность. Несмотря на увеличение количества операций у больных старшей возрастной категории, протезирование аортального клапана характеризуется высокой госпитальной летальностью по сравнению с более молодым контингентом больных. Риск хирургического вмешательства в группе пожилых пациентов связан не только с возрастом, но и с наличием большого количества сопутствующих заболеваний.Цель. Изучить непосредственные результаты протезирования аортального клапана и оценить степень влияния дооперационных факторов риска на показатели хирургического лечения.Материалы и методы. Проведен ретроспективный анализ результатов протезирования аортального клапана у больных старше 65 лет, прооперированных в период с 2011 по 2015 гг. (всего 253 случая). Средний возраст пациентов был 70,4±4,14 лет. Риск операции по шкале EuroSCORE составил 6,09±4,45%. Проанализировано влияние на показатели летальности и послеоперационных осложнений более 30 различных факторов риска.Результаты. Общая госпитальная летальность составила 10,3%. Летальность при изолированном протезировании аортального клапана была на уровне 4,8%, а при сопутствующем коронарном шунтировании – 8,8%. С послеоперационной летальностью статистически достоверно были связаны срочность хирургического вмешательства, наличие острого нарушения мозгового кровообращения в прошлом, ожирение, хроническая почечная недостаточность, хроническая обструктивная болезнь легких, легочная гипертензия, злокачественные новообразования в анамнезе, мультифокальный атеросклероз, дооперационная мерцательная аритмия, IV функциональный класс сердечной недостаточности по NYHA, постстенотическое расширение восходящей аорты, выраженный кальциноз и узкое фиброзное кольцо аортального клапана.Заключение. Протезирование аортального клапана у пациентов пожилого и старческого возраста продемонстрировало результаты, близкие к показателям более молодой категории больных. Высокий риск операции у возрастных пациентов обусловлен, главным образом, сопутствующей экстракардиальной патологией и предоперационными факторами риска

A Case Report of Differential Diagnosis of Causes of Severe Valvular Heart Disease (Takayasu's Arteritis, Infective Endocarditis and Myxomatous Degeneration) with the Key Role of Histological and PCR Examination

Aortic valve lesion is a common and may have diverse causes, from degenerative, congenital and infectious diseases to autoimmune conditions. We present a rare case of Takayasu arteritis and severe heart lesion due to the myxomatous degeneration of the aortic and mitral valves associated with development of infective endocarditis (IE) complicated by abscess, fistula, valve perforation and recurrent acute decompensated heart failure in a young female patient. A combined use of histopathological and PCR analyses of valve tissues was critically important for differential diagnosis of the valve lesions, as it made it possible to identify the true cause of the disease. The presence of Takayasu arteritis has played an indirect role by creating conditions for the development of immunosuppression and determining the disease severity and its progression

A case of successful surgical treatment of infected false aneurysms of the coronary artery after previous stenting

This article presents a case of surgical treatment of a false aneurysm and coronary-left atrial fistula developed after balloon angioplasty and stenting of the circumflex artery. The percutaneous coronary intervention has also led to the development of infective endocarditis of the mitral valve. So far, no descriptions of such complications have been met both in domestic and world literature. This unique clinical case could be useful for novice endovascular surgeons, while experienced cardiovascular surgeons might make use of it when choosing the tactics of surgical treatment.Received 18 September 2017. Revised 13 December 2017. Accepted 15 December 2017.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.Author contributionsI.I. Skopin, P.V. Kakhktsyan were involved in choosing tactics of the surgical treatment. I.I. Skopin revised the article. P.V. Kakhktsyan performed the surgery, searched the literature. G.G. Aleksanyan is the physician, collected data for the article.</p