Kevin R An1, Jessica G Y Luc2, Derrick Y Tam2, Olina Dagher3, Rachel Eikelboom4, Joel Bierer5, Andréanne Cartier6, Thin X Vo7, Olivier Vaillancourt8, Keir Forgie9, Malak Elbatarny1, Sophie Weiwei Gao10, Richard Whitlock10, Wiplove Lamba11, Rakesh C Arora4, Corey Adams3, Bobby Yanagawa12. 1. Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, Canada. 2. Division of Cardiovascular Surgery, University of British Columbia, Vancouver, Canada. 3. Division of Cardiac Surgery, University of Calgary, Calgary, Canada. 4. Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada. 5. Division of Cardiac Surgery, Dalhousie University, Halifax, Canada. 6. University of Laval Faculty of Medicine, Quebec City, Canada. 7. Division of Cardiac Surgery, University of Ottawa Heart Institute, University of Ottawa, Ottawa, Canada. 8. Division of Cardiac Surgery, McGill University, Montreal, Canada. 9. Division of Cardiac Surgery, University of Alberta, Edmonton, Canada. 10. Division of Cardiac Surgery, McMaster University, Hamilton, Canada. 11. Division of Psychiatry, St. Michael's Hospital, University of Toronto, Toronto, Canada. 12. Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, Canada. Electronic address: yanagawab@smh.ca.
Abstract
BACKGROUND: Injection drug use-associated infective endocarditis (IDU-IE) is a growing epidemic. The objective of this survey was to identify the beliefs and practice patterns of Canadian cardiac surgeons regarding surgical management of IDU-IE. METHODS: A 30-question survey was developed by a working group and distributed to all practicing adult cardiac surgeons in Canada. Data were analyzed using descriptive statistics. RESULTS: Of 146 surgeons, 94 completed the survey (64%). Half of surgeons (49%) would be less likely to operate on patients with IE if associated with IDU. In the case of prosthetic valve IE owing to continued IDU, 36% were willing to reoperate once and 14% were willing to reoperate twice or more. Most surgeons required commitments from patients before surgery (73%), and most referred patients to addiction services (81%). Some surgeons would offer a Ross procedure (10%) or homograft (8%) for aortic valve IE, and 47% would consider temporary mechanical circulatory support. Whereas only 17% of surgeons worked at an institution with an endocarditis team, 71% agreed that there was a need for one at each institution. Most surgeons supported the development of IDU-IE-specific guidelines (80%). CONCLUSIONS: Practice patterns and surgical management of IDU-IE vary considerably across Canada. Areas of clinical unmet needs include the development of a formal addiction services referral protocol for patients, the development of an interdisciplinary endocarditis team, as well as the creation of IDU-IE clinical practice guidelines.
BACKGROUND: Injection drug use-associated infective endocarditis (IDU-IE) is a growing epidemic. The objective of this survey was to identify the beliefs and practice patterns of Canadian cardiac surgeons regarding surgical management of IDU-IE. METHODS: A 30-question survey was developed by a working group and distributed to all practicing adult cardiac surgeons in Canada. Data were analyzed using descriptive statistics. RESULTS: Of 146 surgeons, 94 completed the survey (64%). Half of surgeons (49%) would be less likely to operate on patients with IE if associated with IDU. In the case of prosthetic valve IE owing to continued IDU, 36% were willing to reoperate once and 14% were willing to reoperate twice or more. Most surgeons required commitments from patients before surgery (73%), and most referred patients to addiction services (81%). Some surgeons would offer a Ross procedure (10%) or homograft (8%) for aortic valve IE, and 47% would consider temporary mechanical circulatory support. Whereas only 17% of surgeons worked at an institution with an endocarditis team, 71% agreed that there was a need for one at each institution. Most surgeons supported the development of IDU-IE-specific guidelines (80%). CONCLUSIONS: Practice patterns and surgical management of IDU-IE vary considerably across Canada. Areas of clinical unmet needs include the development of a formal addiction services referral protocol for patients, the development of an interdisciplinary endocarditis team, as well as the creation of IDU-IE clinical practice guidelines.
Authors: Alysse G Wurcel; Julia Zubiago; Jessica Reyes; Emma Smyth; Keki R Balsara; Danielle Avila; Joshua A Barocas; Curt G Beckwith; Jenny Bui; Cody A Chastain; Ellen F Eaton; Simeon Kimmel; Molly L Paras; Asher J Schranz; Darshali A Vyas; Alison Rapoport Journal: Ann Thorac Surg Date: 2022-01-31 Impact factor: 5.102