Medical management and surgical techniques
All the patients admitted during the study period were evaluated and managed by a multidisciplinary team involving the figures of cardiologists, cardiac surgeons, intensivists and microbiologists. Further support when needed was obtained by cardiothoracic radiologists, vascular surgeons, neurologists, neurosurgeons and general surgeons. Antibiotic therapy was based on results of blood/specimen cultures or empirical therapy was provided according to guidelines (14); usually the treatment was maintained for 6 weeks. Surgery was always performed during the index hospitalisation. Timing of surgery varied according to the clinical scenario, anatomical findings and complications. A large ischaemic area or the presence of brain haemorrhage led to a delayed operation (as recommended at least 4 weeks) in case of stable haemodynamic and low risk of recurrent embolism.
All the operations were performed through a redo sternotomy. Radical debridement of all infective tissue and removal of necrotic tissue and prosthetic material were performed. Tissue and prosthetic specimens were always sent for culture and microbiologist evaluation. A new aortic prosthesis was then implanted, associated procedures were performed based on the extension of the infective process and the involvement of other cardiac structures.
Follow-up assessment was arranged at our outpatient clinic.