[HSF] re: endocarditis- New pt

Fri Jan 4 09:03:23 EST 2008

It amazes me how much resistance we get from some ID folks when we use the
term "lifetime" antibiotics.  I am sure there is no data, but it does make a
lot of sense (beside transplant/HIV/etc patients often get bactrim for life)

-michael

On 1/4/08, tdmartin2000 at aol.com <tdmartin2000 at aol.com> wrote:
>
>
> My partner Phil Hess and I did a case of a infected valve conduit
> yesterday in a 42yr old pt who had the conduit placed 4 mo ago at an outside
> hospital. The bug was MSSA and there were abcesses in several areas around
> the dacron and a very inflamed area at the annulus in the noncoronary
> sinus/anterior leaflet area but no purulence at this area. It was one of the
> hardest redo's we've done (and that's saying a lot). We were able to debride
> back to good tissue in all areas and 80% of the annulus was intact without
> any evidence of infection. Due to her age and the difficulty of her
> operation we elected to put in another valve conduit. We also used some
> voodoo- ie we poured powdered Vancomycin on the rifampin soaked graft and we
> left a 18ga red rubber catheter over the graft through which we will infuse
> a dilute gentamicin solution for the next week. She will then get a total of
> 6wks of IV antibiotics and then take LIFETIME oral suppressive antibiotics.
> This is the protocol we hav
> e used for over 10 yrs and we see very few of these come back with
> recurrent endocarditis. I don't know the exact numbers but it is
> significant.
>
>
>
> Tom Martin
>
> U of Florida
>
> Gainesville
>
>
> -----Original Message-----
> From: zzhoumd at pol.net
> To: OpenHeart-L at lists.hsforum.com
> Sent: Wed, 2 Jan 2008 11:13 pm
> Subject: Re: [HSF] re: Homograft vs Freestyle for endocarditis
>
>
>
>
>
> Thanks!
>
> Z Zhou
>
> Sent via BlackBerry by AT&T
>
> -----Original Message-----
> From: tdmartin2000 at aol.com
>
> Date: Wed, 02 Jan 2008 21:36:08
> To:OpenHeart-L at lists.hsforum.com
> Subject: Re: [HSF] re: Homograft vs Freestyle for endocarditis
>
>
> I used to use homografts in all pts with aortic endocarditis as we felt
> the risk
> of recurrent endocarditis was lower that with other prostheses. The UAB
> experience that I recall seemed to have a sig lower recurrent endocarditis
> with
> homografts but I don't know the numbers exactly. Many places and surgeons
> have
> over the last 10 yrs or so focused more on radical debridement and
> reconstruction and not necessarily on the type of valve. It is currently
> my
> practice to use a homograft in the setting of a significant active
> infective
> process whre the annulus is destroyed and abcesses are present. If there
> is no
> abcess or the annulus is easily debrided and reconstructed then I would
> and have
> used some type of prosthesis. The key is agressive radical debridement to
> good
> tissue, at least 6 weeks of IV antibiotics and lifetime suppressive
> antibiotics,
> in my opinion.
>
> Tom Martin
> U of Florida
> GAinesville
>
>
> -----Original Message-----
> From: hgrmd at aol.com
> To: OpenHeart-L at lists.hsforum.com
> Sent: Wed, 2 Jan 2008 2:39 pm
> Subject: Re: [HSF] re: Porcine vs pericardial for Hal and others
>
>
>
>
> Dear Zhadong,
>
> ? Though I don't have recent experience with it, I plan to?do my next root
> abscess with a stentless valve.
>
>
> -----Original Message-----
> From: zzhoumd at pol.net
> To: OpenHeart-L at lists.hsforum.com
> Sent: Wed, 2 Jan 2008 1:49 pm
> Subject: Re: [HSF] re: Porcine vs pericardial for Hal and others
>
>
>
>
>
> Now I have a patient with root abscess from enteroccocus. Which valve to
> use,
> homograft vs freestyle bentall?
>
> Z Zhou
>
>
> Sent via BlackBerry by AT&T
>
> -----Original Message-----
> From: Ani Anyanwu <anianyanwu at hotmail.com>
>
> Date: Wed, 2 Jan 2008 15:16:05
> To:<openheart-l at lists.hsforum.com>
> Subject: RE: [HSF] re: Porcine vs pericardial for Hal and others
>
>
> > > Ani,> Not to quibble, but the CCF paper you cited had more AI than AS
> as the
>
>
> > cause of failures in pericardial valves. > > Hal>
>
> Yes Hal which is why I said that the teaching pericardial fail by
> stenosis,
> porcine by regurgitation does not reflect the whole truth but only part of
> the
> truth.
>
> There is however an association. Just like with Bicuspid valves = aortic
> stenosis hypothesis. Most bicuspid valves will never be stenotic and most
> stenotic valves are not bicuspid but that does not mean stenosis is not a
> more
> frequent occurrence in bicuspid valves than tricuspid valves (as we know
> it is).
>
> I will however say that our recollections are tainted by our biases. I
> suspect
> if you objectively looked at your data *on reop avrs* you would find very
> few
> cases where a porcine valve was replaced for pure stenosis (i.e. the
> integrity
> of the cusps was maintained). Now you have heard tom martin mention this
> you
> will probably start seeing the converse and noticing most porcine valves
> you
> explant *for structural degeneration* do calcify, leak and have torn
> cusps.
> Indeed part of the reason you may not have observed this is because your
> experience in rereplacing pericardial valves is comparatively limited
> compared
> to porcine (i think you have said in the past that you have only seen a
> handful
> of pericardial valves come back for degeneration, but done loads of
> porcine).
> Another thing possibly tainting your observation is your large volume
> mitral
> practice. These observations apply to the aortic position - in the mitral
> position it is rather different and porcine valves do also stenose.
>
> Ani
>
>
>
>
> > From: Hgrmd at aol.com> Date: Wed, 2 Jan 2008 07:31:44 -0500> Subject: Re:
> [HSF]
> re: Porcine vs pericardial for Hal and others> To:
> OpenHeart-L at lists.hsforum.com>
>
>
> CC: > > > **************************************See AOL's top rated
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