Our Summary

This paper looks at the outcomes of different treatments for infective endocarditis (IE), a heart infection, in people who have had a certain type of heart valve replacement (TPVR). Using a database of pediatric health information, the researchers found 69 cases of IE in patients who had undergone TPVR.

They found that 29% of these patients were readmitted to the hospital due to the infection. Of those who initially only received medication for their infection, 33% had a relapse. Patients who initially had surgery were more likely to experience kidney and respiratory failure.

Overall, the death rate was 4.3%, but this rose to 8% in those who had surgery. The researchers concluded that while medication can lead to relapses and readmissions, surgery seems to be the most effective treatment, even though it carries a higher risk of complications and death. They suggest that a more aggressive course of treatment may be more likely to prevent a relapse in patients who are only treated with medication.

FAQs

  1. What are the readmission and relapse rates for patients with infective endocarditis who have undergone TPVR?
  2. Is surgery or medication more effective for treating infective endocarditis in patients who have had TPVR?
  3. What are the risks associated with surgical treatment of infective endocarditis in patients who have had TPVR?

Doctor’s Tip

A doctor might tell a patient about valve replacement:

It is important to follow up regularly with your healthcare provider after valve replacement surgery to monitor for any signs of infection, such as fever, chills, or shortness of breath. If you experience any of these symptoms, it is important to seek medical attention promptly. Additionally, taking antibiotics as prescribed by your doctor can help prevent infections and complications after surgery.

Suitable For

Patients who are typically recommended valve replacement are those with severe valve disease, such as aortic stenosis or mitral regurgitation, that is causing symptoms such as shortness of breath, chest pain, or fatigue. In the case of infective endocarditis, patients who have had a TPVR and develop an infection may also be recommended valve replacement if medication treatment is not effective in clearing the infection.

Timeline

Before valve replacement:

  1. Patient may experience symptoms of heart valve disease, such as chest pain, shortness of breath, fatigue, dizziness, and swelling in the legs and abdomen.
  2. Patient may undergo various tests, such as echocardiogram, MRI, and blood tests, to diagnose the condition.
  3. Patient may be prescribed medication to manage symptoms and prevent complications.
  4. Patient may be advised to make lifestyle changes, such as quitting smoking, eating a heart-healthy diet, and exercising regularly.

After valve replacement:

  1. Patient undergoes valve replacement surgery, either through traditional open-heart surgery or minimally invasive procedures.
  2. Patient may need to stay in the hospital for a few days to recover from the surgery.
  3. Patient will be prescribed medication to prevent infection and blood clots, as well as to manage any underlying heart conditions.
  4. Patient will need to attend follow-up appointments with their healthcare provider to monitor their recovery and adjust their treatment plan as needed.
  5. Patient will need to make long-term lifestyle changes, such as taking medications as prescribed, following a heart-healthy diet, exercising regularly, and avoiding smoking and excessive alcohol consumption.

What to Ask Your Doctor

  1. What are the different treatment options for infective endocarditis in patients with a certain type of heart valve replacement, such as TPVR?
  2. What are the potential risks and benefits of each treatment option?
  3. How likely am I to experience a relapse or readmission if I only receive medication for my infection?
  4. What are the potential complications and risks associated with surgery for infective endocarditis in patients with a heart valve replacement?
  5. What is the overall mortality rate for patients with infective endocarditis who have undergone TPVR?
  6. How does the mortality rate compare between patients who receive medication only versus those who undergo surgery?
  7. What factors should I consider when deciding between medication and surgery for treating my infective endocarditis?
  8. How can I prevent a relapse in my condition if I choose to only receive medication?
  9. Are there any specific precautions or lifestyle changes I should take after undergoing surgery for infective endocarditis?
  10. Are there any long-term implications or risks associated with having had infective endocarditis and a heart valve replacement?

Reference

Authors: Fox JC, Carvajal HG, Wan F, Canter MW, Merritt TC, Eghtesady P. Journal: World J Pediatr Congenit Heart Surg. 2023 Jan;14(1):12-20. doi: 10.1177/21501351221129194. PMID: 36847769