Surgical Intervention of Infective Endocarditis in Intravenous Drug Addicts

Abstract

IVDA is a social, health, and economic burden in developed and developing countries. 7.7% of the IE patients were IVDAs. The diagnosis of IE must be made as soon as possible to initiate appropriate empirical antibiotic therapy and to identify patients at high risk for complications who may be best managed by early surgery.The primary goal of antibiotic treatment is to eradicate infection, including sterilizing vegetations, Decisions of surgical intervention are complex and depend on many clinical and prognostic factors that vary among patients, including infecting organism, vegetation size, presence of perivalvular infection, presence of embolism or heart failure, age, noncardiac comorbidities, and available surgical expertise. Mitral valve repair is superior to replacement in the setting of IE.Patients with mitral valve IE are often young, and mitral repair compared with replacement confers a long-term survival advantage. Replacement of the aortic valve using a mechanical or biological prosthesis is the technique of choice. However, experience with aortic valve repair in this setting is still very limited and there is no evidence that repair is associated with improved outcomes compared with replacement.Owing to their natural biocompatibility, the use of cryopreserved or sterilized homografts has been suggested to reduce the risk of persistent or recurrent infection, especially in the presence of annular abscesses.A monoblock aorto-mitral homograft has been suggested as a surgical option for extensive bivalvular IE. Tricuspid valve IE differs from left-sided IE in that the majority of cases are managed medically. The management of TV IE in active IVDAs whosemanagement remains challenging due to: delayed presentation (often in a more critical condition), multi-valve involvement, po