Sharing of decision-making for infective endocarditis surgery: a narrative review of clinical and ethical implications
Pollari F, Spadaccio C, Cuomo M, Chello M, Nenna A, Fischlein T, Nappi F (2020)
Publication Type: Journal article, Review article
Publication year: 2020
Journal
Book Volume: 8
Journal Issue: 23
DOI: 10.21037/atm-20-4626
Abstract
Infective endocarditis (IE) is nowadays one of the most challenging disease in cardiac surgery because of its multifaceted clinical and anatomical presentation. Despite the many clinical and surgical advances achieved in the past 60 years, there is a lack of evidence regarding the ideal strategy. The present review aims to investigate and highlight two main novel concepts for the decision-making of the best substitute. Firstly, the concept of an "endocarditis team": a coordinated multidisciplinary effort in the diagnostic work-up, especially in conditions of high risk of embolization or clinical deterioration. A good "endocarditis team" has the role to overcome such problem, in order to ensure a prompt and balanced strategy. Secondly, which ethical considerations are required to drive the choice of valvular substitute. The choice of best valve substitute is a relevant issue of debate, not only with operative but also prognostic and accordingly ethical aftermaths. Many different solutions have been developed to substitute the infected valve. Among these: mechanical prosthesis (MP), biological stented prosthesis (BP), sutureless bioprosthesis and cryopreserved homografts (CHs). Patients need to be informed in detail about the technical issues pertaining the use of these valve substitute. We will discuss the evidences regarding the risk of recurrent infections or future potentially severe calcification of aortic homograft valve and wall (in other words, the failure of the homograft) and the difficulties in managing the reoperation.
Involved external institutions
Klinikum Nürnberg
Germany (DE)
Campus Bio-Medico University of Rome
Italy (IT)
Golden Jubilee National Hospital
United Kingdom (GB)
Centre Cardiologique du Nord (CCN)
France (FR)
Germany (DE)
Campus Bio-Medico University of Rome
Italy (IT)
Golden Jubilee National Hospital
United Kingdom (GB)
Centre Cardiologique du Nord (CCN)
France (FR)
How to cite
APA:
Pollari, F., Spadaccio, C., Cuomo, M., Chello, M., Nenna, A., Fischlein, T., & Nappi, F. (2020). Sharing of decision-making for infective endocarditis surgery: a narrative review of clinical and ethical implications. Annals of Translational Medicine, 8(23). https://dx.doi.org/10.21037/atm-20-4626
MLA:
Pollari, Francesco, et al. "Sharing of decision-making for infective endocarditis surgery: a narrative review of clinical and ethical implications." Annals of Translational Medicine 8.23 (2020).
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