I Machelart1, C Greib1, G Wirth2, F Camou3, N Issa3, J F Viallard1, J L Pellegrin1, E Lazaro1. 1. Department of Internal Medicine and Infectious Diseases, Haut-Lévêque Hospital, Pessac, France. 2. Department of Infectious Diseases, Pellegrin Hospital, Bordeaux, France. 3. Medical Intensive Care Unit, Saint André Hospital, Bordeaux, France.
Abstract
INTRODUCTION: The Bentall procedure is a cardiac surgery involving graft replacement of the aortic valve, aortic root and ascending aorta. Graft infection after Bentall's procedure (BGI) is infrequent but severe, and often difficult to diagnose and treat. PATIENTS AND METHODS: A retrospective cohort study was performed using the Bordeaux endocarditis database of adult patients admitted to the Bordeaux University Medical Hospital for BGI between 2008 and 2014. Published case reports were identified in the literature. RESULTS: We identified 10 BGI patients in the database and 13 in the literature. The majority of infections were late-onset (20/23) and occurred as a result of gram positive cocci bacterial infection (16/22). Detailed diagnoses of the described BGI were determined using echocardiography, computed tomography (CT) and positron emission tomography/CT (PET/CT). Labeled-leukocyte scintigraphy was not reported in any case. Prolonged antibiotic therapy and surgery were found to be the treatment of choice for BGI; however it was not always possible to perform a surgical intervention. Clinical relapses occurred even with a negative PET/CT, while PET/CT consistently positive for BGI occurred in the absence of clinical relapse. This suggests that the use of PET/CT for follow-up is questionable. CONCLUSION: Diagnosis of BGI is difficult, due to the combination of clinical, biological, and radiological observations obtained through transesophageal echocardiography and CT. PET/CT is an alternative method to diagnosis BGI, but its impact on clinical management remains unclear. Current data suggests that if surgical replacement of the prosthesis is not possible, patients should be treated with prolonged antibiotic therapy.
INTRODUCTION: The Bentall procedure is a cardiac surgery involving graft replacement of the aortic valve, aortic root and ascending aorta. Graft infection after Bentall's procedure (BGI) is infrequent but severe, and often difficult to diagnose and treat. PATIENTS AND METHODS: A retrospective cohort study was performed using the Bordeaux endocarditis database of adult patients admitted to the Bordeaux University Medical Hospital for BGI between 2008 and 2014. Published case reports were identified in the literature. RESULTS: We identified 10 BGI patients in the database and 13 in the literature. The majority of infections were late-onset (20/23) and occurred as a result of gram positive cocci bacterial infection (16/22). Detailed diagnoses of the described BGI were determined using echocardiography, computed tomography (CT) and positron emission tomography/CT (PET/CT). Labeled-leukocyte scintigraphy was not reported in any case. Prolonged antibiotic therapy and surgery were found to be the treatment of choice for BGI; however it was not always possible to perform a surgical intervention. Clinical relapses occurred even with a negative PET/CT, while PET/CT consistently positive for BGI occurred in the absence of clinical relapse. This suggests that the use of PET/CT for follow-up is questionable. CONCLUSION: Diagnosis of BGI is difficult, due to the combination of clinical, biological, and radiological observations obtained through transesophageal echocardiography and CT. PET/CT is an alternative method to diagnosis BGI, but its impact on clinical management remains unclear. Current data suggests that if surgical replacement of the prosthesis is not possible, patients should be treated with prolonged antibiotic therapy.
Authors: Paola Anna Erba; Francesco Bartoli; Martina Sollini; Berchiolli Raffaella; Roberta Zanca; Esposito Enrica; Elena Lazzeri Journal: Curr Cardiol Rep Date: 2022-06-13 Impact factor: 3.955
Authors: Lars Husmann; Martin W Huellner; Nadia Eberhard; Bruno Ledergerber; Marisa B Kaelin; Alexia Anagnostopoulos; Ken Kudura; Irene A Burger; Carlos-A Mestres; Zoran Rancic; Barbara Hasse Journal: Sci Rep Date: 2021-03-03 Impact factor: 4.379
Authors: Martina Sollini; Francesco Bartoli; Roberto Boni; Roberta Zanca; Andrea Colli; Maurizio Levantino; Francesco Menichetti; Mauro Ferrari; Raffaella Berchiolli; Elena Lazzeri; Paola A Erba Journal: Front Cardiovasc Med Date: 2021-12-01