ENDOCARDITE AIGUE INFECTIEUSE TRAITEMENT...

NOM Intitulé du topo Date ….

ENDOCARDITE AIGUE INFECTIEUSETRAITEMENT CHIRURGICAL

Pr Fadi FARHAT

Service de Chirurgie Cardiovasculaire Adulte et Transplantation

Hôpital Louis Pradel, Bron, FRANCE

2ème Journée Scientifique de la Réunion de Concertation Pluridisciplinaire sur l’Endocardite Infectieuse du

CHU de Lyon


Conclusion

Discussion

Résultats

Timing?

INTRO

TRAITEMENT CHIRURGICAL DES ENDOCARDITES INFECTIEUSES

• Quand doit-on opérer ?

• Quel geste peut-on / doit-on

réaliser ?


Conclusion

Discussion

Résultats

Timing?

Quand doit-on opérer ?

INTRO


Problématique :

− Plus l’intervention chirurgicale est réalisée précocement,

plus le risque de récidive infectieuse est important.

− Plus elle est tardive, plus le risque de complications

augmente.


Conclusion

Discussion

Résultats

Timing?

INTRO


Quand doit-on opérer ?

Indications "anatomiques" :

− Abcès annulaire volumineux, évoluant, compliqué d’un

BAV

− Communications aortocardiaques (Aorte-OG, Aorte-

OD) et CIV


Conclusion

Discussion

Quel geste chirurgical?

Timing?

Quel geste peut-on réaliser ?

INTRO


Principes du traitement chirurgical :

− Analyse des lésions : valve, anneau, culot aortique, septum inter-ventriculaire, trigone mitro-aortique…

− Excision complète et extensive des tissus infectés

− Reconstruction anatomique des structures lésées


Conclusion

Résultats


Timing?

INTRO


Reconstructions valvulaires


Conclusion

Discussion


Timing?

INTRO


Reconstruction de l’anneau mitral


Conclusion

Discussion


Timing?

INTRO


Reconstruction de l’anneau mitral postérieur

d'Udekem, David, et al. Ann Thorac Surg 1996


Conclusion

Discussion


Timing?

INTRO


Continuité mitro- aortique


Conclusion

Discussion


Timing?

INTRO


Continuité mitro- aortique

d'Udekem, David, et al. Ann Thorac Surg 1996


Conclusion

Discussion


Timing?

INTRO



Conclusion

Discussion


Timing?

INTRO


Bloc mitro aortique mécanique pour endocardite sur prothèse (2ème récidive en 2008, survie à 7 ans)


Conclusion

Résultats


Timing?

INTRO


Farhat, Interactive Cardiovasc Thorac Surg 2007


Conclusion

Discussion


Timing?

INTRO


Byrne, Ann Thorac Surg 2011

- Revue de la littérature de 2000 à 2010

- Visant à établir des bonnes pratiques chirurgicales sur l’approche technique ainsi que le type de prothèse à implanter


Conclusion

Discussion


Timing?

INTRO



Endocardite aortique sur valve native


Conclusion

Discussion


Timing?

INTRO



Endocardite aortique sur valve native avec

abcès périvalvulaire


Conclusion

Discussion


Timing?

INTRO


Endocardite aortique sur prothèse valvulaire



Conclusion

Discussion


Timing?

INTRO


Endocardite aortique sur prothèse valvulaire

avec abcès périvalvulaire



Conclusion

Discussion


Timing?

INTRO


Endocardite mitrale sur valve native



Conclusion

Discussion


Timing?

INTRO


Endocardite mitrale sur prothèse valvulaire



Conclusion

Discussion


Timing?

INTRO


Endocardite valvulaire tricuspide



Conclusion

Discussion


Timing?

INTRO



Endocardite valvulaire multiple


Conclusion

Résultats


Timing?

INTRO


David, Eur J Cardiothorac Surg 2006


Conclusion

Résultats


Timing?

INTRO


BACKGROUND:Nearly half of patients require cardiac surgery during the acute phase of infective endocarditis (IE). We describe the characteristics of patients according to the type of valve replacement (mechanical or biological), and examine whether the type of prosthesis was associated with in-hospital and 1-year mortality.METHODS AND RESULTS:Among 5591 patients included in the International Collaboration on Endocarditis Prospective Cohort Study, 1467 patients with definite IE were operated on during the active phase and had a biological (37%) or mechanical (63%) valve replacement. Patients who received bioprostheses were older (62 vs 54years), more often had a history of cancer (9% vs 6%), and had moderate or severe renal disease (9% vs 4%); proportion of health care-associated IE was higher (26% vs 17%); intracardiacabscesses were more frequent (30% vs 23%). In-hospital and 1-year death rates were higher in the bioprosthesis group, 20.5% vs 14.0% (p=0.0009) and 25.3% vs 16.6% (p<.0001), respectively. In multivariable analysis, mechanical prostheses were less commonly implanted in older patients (odds ratio: 0.64 for every 10years), and in patients with a history of cancer (0.72), but were more commonly implanted in mitral position (1.60). Bioprosthesis was independently associated with 1-year mortality (hazard ratio: 1.298).CONCLUSIONS:Patients with IE who receive a biological valve replacement have significant differences in clinical characteristics compared topatients who receive a mechanical prosthesis. Biological valve replacement is independently associated with a higher in-hospitaland 1-year mortality, a result which is possibly related to patient characteristics rather than valve dysfunction.

Delahaye, Int J Cardiol 2015

One-year outcome following biological or mechanical valve replacement for infective endocarditis


Conclusion

Résultats


Timing?

INTRO


BACKGROUND:Acute bacterial endocarditis may be extremely destructive for cardiac valves and their periannular structures. It has been suggested that complex reconstruction procedures require the use of homografts because of their versatility and potency to resist repeated infection.METHODS:We studied the long-term results of 69 patients with complex endocarditis who received homografts in the aortic position.RESULTS:The results after a mean follow-up of 8.1 ± 5.1 years (median, 8.0 years) showed that the recurrence of endocarditis even in these complex cases is low (7%), but the incidence of structural valve degeneration (SVD) is high. Freedom from SVD at 10 years is only 60.0%. When aortic homografts degenerate, they predominantly calcify.CONCLUSIONS:The use of homografts to reconstruct endocarditis-related aortic valve destruction is associated with a low recurrence of endocarditis but a high incidence of SVD in the long run.

Durability of homografts used to treat complex aortic valve endocarditis

Flameng, Ann Thorac Surg 2015


Conclusion

Résultats


Timing?

INTRO


− Analyse des lésions pour traitement adapté

− Excision complète et extensive des tissus infectés

− Reconstruction anatomique des structures lésées

− Pas de matériau prothétique préférentiel : attitude au cas par cas

Conclusion

ENDOCARDITE AIGUE INFECTIEUSE TRAITEMENT...

Documents

Transcript of ENDOCARDITE AIGUE INFECTIEUSE TRAITEMENT...