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Review
. 2019 Nov;8(6):630-644.
doi: 10.21037/acs.2019.10.05.

Current AATS guidelines on surgical treatment of infective endocarditis

Gösta B Pettersson  1 , Syed T Hussain  2
Affiliations
Review

Current AATS guidelines on surgical treatment of infective endocarditis

Gösta B Pettersson et al. Ann Cardiothorac Surg. 2019 Nov.

Abstract

The 2016 American Association for Thoracic Surgery (AATS) guidelines for surgical treatment of infective endocarditis (IE) are question based and address questions of specific relevance to cardiac surgeons. Clinical scenarios in IE are often complex, requiring prompt diagnosis, early institution of antibiotics, and decision-making related to complications, including risk of embolism and timing of surgery when indicated. The importance of an early, multispecialty team approach to patients with IE is emphasized. Management issues are divided into groups of questions related to indications for and timing of surgery, pre-surgical work-up, preoperative antibiotic treatment, surgical risk assessment, intraoperative management, surgical management, surveillance, and follow up. Standard indications for surgery are severe heart failure, severe valve dysfunction, prosthetic valve infection, invasion beyond the valve leaflets, recurrent systemic embolization, large mobile vegetations, or persistent sepsis despite adequate antibiotic therapy for more than 5-7 days. The guidelines emphasize that once an indication for surgery is established, the operation should be performed as soon as possible. Timing of surgery in patients with strokes and neurologic deficits require close collaboration with neurological services. In surgery infected and necrotic tissue and foreign material is radically debrided and removed. Valve repair is performed whenever possible, particularly for the mitral and tricuspid valves. When simple valve replacement is required, choice of valve-mechanical or tissue prosthesis-should be based on normal criteria for valve replacement. For patients with invasive disease and destruction, reconstruction should depend on the involved valve, severity of destruction, and available options for cardiac reconstruction. For the aortic valve, use of allograft is still favored.

Keywords: AATS guidelines; infective endocarditis; native valve endocarditis; prosthetic valve endocarditis.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Team approach to patients with IE. Reproduced from Pettersson GB, Coselli JS, Hussain ST, et al. 2016 American Association for Thoracic Surgery (AATS) Consensus Guidelines: Surgical Treatment of Infective Endocarditis. J Thorac Cardiovasc Surg 2017;153:1241-1258.e29, with permission from Elsevier.
Figure 2
Figure 2
Indications for and timing of surgery for patients with IE. Reproduced from Pettersson GB, Coselli JS, Hussain ST, et al. 2016 American Association for Thoracic Surgery (AATS) Consensus Guidelines: Surgical Treatment of Infective Endocarditis. J Thorac Cardiovasc Surg 2017;153:1241-1258.e29, with permission from Elsevier.
Figure 3
Figure 3
Pre-surgical work-up and management of patients with IE. Reproduced from Pettersson GB, Coselli JS, Hussain ST, et al. 2016 American Association for Thoracic Surgery (AATS) Consensus Guidelines: Surgical Treatment of Infective Endocarditis. J Thorac Cardiovasc Surg 2017;153:1241-1258.e29, with permission from Elsevier.
Figure 4
Figure 4
Additional work-up, preoperative antibiotics, and risk of operation for patients with IE. Reproduced from Pettersson GB, Coselli JS, Hussain ST, et al. 2016 American Association for Thoracic Surgery (AATS) Consensus Guidelines: Surgical Treatment of Infective Endocarditis. J Thorac Cardiovasc Surg 2017;153:1241-1258.e29, with permission from Elsevier.
Figure 5
Figure 5
General features of intraoperative management of patients with IE. Reproduced from Pettersson GB, Coselli JS, Hussain ST, et al. 2016 American Association for Thoracic Surgery (AATS) Consensus Guidelines: Surgical Treatment of Infective Endocarditis. J Thorac Cardiovasc Surg 2017;153:1241-1258.e29, with permission from Elsevier.
Figure 6
Figure 6
Specific considerations in surgical management of patients with IE. Reproduced from Pettersson GB, Coselli JS, Hussain ST, et al. 2016 American Association for Thoracic Surgery (AATS) Consensus Guidelines: Surgical Treatment of Infective Endocarditis. J Thorac Cardiovasc Surg 2017;153:1241-1258.e29, with permission from Elsevier.
Figure 7
Figure 7
Surveillance and special considerations for patients with IE. Reproduced from Pettersson GB, Coselli JS, Hussain ST, et al. 2016 American Association for Thoracic Surgery (AATS) Consensus Guidelines: Surgical Treatment of Infective Endocarditis. J Thorac Cardiovasc Surg 2017;153:1241-1258.e29, with permission from Elsevier.
Video
Video
Current AATS guidelines on surgical treatment of infective endocarditis.
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References

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