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.