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Cited by 110Infective Endocarditis Diagnosis and ManagementInfectious Aortic and Vascular ConditionsCardiac Valve Diseases and Treatments

Surgical and long-term antifungal therapy for fungal prosthetic valve endocarditis

Muehrcke, Derek D., Lytle, Bruce W., Cosgrove, Delos M.·1995·The Annals of Thoracic Surgery
DOI 10.1016/0003-4975(95)00469-2
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Abstract

Background Fungal prosthetic valve endocarditis is an uncommon but serious disease. We have developed a strategy of treatment that includes perioperative amphotericin B, radical debridement of infected tissue, reconstruction using biologic tissue when possible, and prolonged oral suppressive antifungal therapy.Methods We retrospectively reviewed the charts of 12 patients reoperated on for fungal prosthetic valve endocarditis involving the aortic valve (10 patients: six porcine valves, two mechanical valves, two homografts) and the mitral valve (2 patients, both porcine valves). Prosthetic valve endocarditis developed in 7 within 12 months after the first valve procedure. The organisms included Candida species (9 patients), Scopulariopsis brevicaulis (1), Saccharomyces cervisiae (1), and histoplasmosis (1).Results At operation, all patients had prosthetic vegetations, 8 had abscesses, and 4 had sinus tracts. Seven received aortic homografts, 4 received porcine valves (two mitral), and 1 received a mechanical prosthesis. Two patients died in the hospital after prolonged illnesses (83% hospital survival). Four patients had recurrence an average of 25 months later and 3 underwent further surgical intervention. One patient had recurrence and died 17 months postoperatively. One other late death occurred 96 months after operation, and there was no evidence of recurrence. Eight patients (67%) are alive and well 51.5 +/- 61.0 months (range, 1 to 189 months) after the first redo procedure for fungal prosthetic valve endocarditis.Conclusions We conclude that preoperative treatment with amphotericin B, radical resection of all infected tissue, cardiac reconstruction using biologic tissue when possible, and life-long oral antifungal therapy is effective for fungal prosthetic valve endocarditis.

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Crossref · 10.1016/0003-4975(95)00469-2

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  • Removal of infected valves, resection of infected peripheral veins, and debridement of infected pericardial tissue are almost always required for successful therapy of candidal endocarditis, pericarditis, and suppurative phlebitis.

    “removal of infected valves, resection of infected peripheral veins, and debridement of infected pericardial tissue are almost always required for successful therapy [218,219].”

    From Guidelines for Treatment of Candidiasis (2004) · cites this paper as [218]

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Authors
Muehrcke, D. D., Lytle, B. W., & Cosgrove, D. M.
Affiliations
Cleveland Clinic (US)
ORCID
Venue
The Annals of Thoracic Surgery
Publisher
Elsevier BV
Published
1995-09
Volume
60
Issue
3
Pages
538-543
ISSN
0003-4975 (ISSN-L)
DOI
10.1016/0003-4975(95)00469-2
OpenAlex
W1992132599
Cited by
110
References
24
Citations by year
2025: 1 · 2024: 3 · 2023: 2 · 2022: 1 · 2021: 2 · 2020: 2 · 2019: 2 · 2018: 2 · 2017: 1 · 2016: 3 · 2015: 5 · 2014: 4 · 2013: 3 · 2012: 3
FWCI
4.71
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • The Annals of Thoracic Surgery (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Epidemiology › Infective Endocarditis Diagnosis and Management
  • Health Sciences › Medicine › Surgery › Infectious Aortic and Vascular Conditions
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Valve Diseases and Treatments
Keywords
amphotericin B, radical debridement, oral antifungal therapy, aortic valve replacement, mitral valve replacement, aortic homograft, Candida, long-term survival
MeSH terms
Abscess, Adult, Aged, Antifungal Agents, Aortic Valve, Bioprosthesis, Candidiasis, Combined Modality Therapy, Endocarditis, Female, Fistula, Follow-Up Studies, Heart Valve Diseases, Heart Valve Prosthesis, Humans, Male, Middle Aged, Mitral Valve, Recurrence, Reoperation, Retrospective Studies, Transplantation, Homologous, Survival Rate

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