Prof. Luc Piérard,
Dr Herring (CONTRA) asked 2 questions: how urgent the echo and what sort of echo? He proposed that the routine use of echo is justified in patients with a prosthetic valve or an intracardiac device. He showed an algorithm in the other patients taking into account high vs low risk. Low risk includes catheter-related SB or easy control of the infection. In conclusion, the use of echocardiography described in the 2009 ESC Guidelines remains clear and valid.
The second debate was entitled: Early surgery is mandatory in left-sided IE.
The 2 speakers agreed that a multidisciplinary team approach is required in all patients. Definitions of early surgery may differ: within the first week? During the hospital stay? When the patient is still under antimicrobial therapy? Prosthetic valve IE requires surgery in > 50% of patients. Native valve IE should undergo surgery in the presence of heart failure, uncontrolled infection, paravalvular complications, systemic embolisation, very high embolic risk and infection by staphylococcus aureus.
Dr Antunes (CONTRA) mentioned the risks of early surgery: higher mortality, higher rate of prosthetic infection or non infective dehiscence. He proposed that, when possible, elective surgery should be preferred. Dr Mestres (PRO) mentioned that well powered randomised clinical trials are not available and difficult to organise. The ESC Guidelines were reviewed and again, appear to remain appropriate.
Session Title: Infective endocarditis - guidelines on trial
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