Non-bacterial thrombotic endocarditis surgery: Difference between revisions

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{{Non-bacterial thrombotic endocarditis}}
{{Non-bacterial thrombotic endocarditis}}
{{CMG}}; {{AE}}{{Homa}}
{{CMG}}; {{AE}}{{Aisha}}
==Overview==
==Overview==
Surgical intervention is not recommended for the management of [disease name].
Surgery is not the first-line treatment option for patients with non-bacterial thrombotic endocarditis and is usually reserved for patients with either heart failure, acute valve rupture, or recurrence of thromboembolism despite adequate anticoagulation. It is important to weigh the risks associated with the patient's underlying condition with the benefits of surgery.
 
OR
 
Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]
 
OR
 
The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].
 
OR
 
The feasibility of surgery depends on the stage of [malignancy] at diagnosis.
 
OR
 
Surgery is the mainstay of treatment for [disease or malignancy].


==Indications==
==Indications==
 
*Surgery is not the first-line treatment option for patients with non-bacterial thrombotic endocarditis<ref name="pmid8875919">{{cite journal |vauthors=Roldan CA, Shively BK, Crawford MH |title=An echocardiographic study of valvular heart disease associated with systemic lupus erythematosus |journal=N. Engl. J. Med. |volume=335 |issue=19 |pages=1424–30 |date=November 1996 |pmid=8875919 |doi=10.1056/NEJM199611073351903 |url=}}</ref>.  
*Surgical intervention is not recommended for the management of [disease name].
*Surgery to replace or repair the valve is usually reserved for patients with either heart failure, acute valve rupture, or recurrence of thromboembolism despite adequate anticoagulation<ref name="pmid15726628">{{cite journal |vauthors=Rabinstein AA, Giovanelli C, Romano JG, Koch S, Forteza AM, Ricci M |title=Surgical treatment of nonbacterial thrombotic endocarditis presenting with stroke |journal=J. Neurol. |volume=252 |issue=3 |pages=352–5 |date=March 2005 |pmid=15726268 |doi=10.1007/s00415-005-0660-z |url=}}</ref>.
OR
*Mitral valve replacement surgery has an operative mortality of as high as 25% in patients with Libman-Sacks endocarditis.
*Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either:
*The main reason for surgery in NBTE is the prevention of recurrent thromboembolism.
**[Indication 1]
*As opposed to infective endocarditis where the entire valve may need to be removed, valve preservation is possible in NBTE<ref name="urlNon-bacterial Thrombotic Endocarditis | IntechOpen">{{cite web |url=https://www.intechopen.com/books/infective-endocarditis/non-bacterial-thrombotic-endocarditis |title=Non-bacterial Thrombotic Endocarditis &#124; IntechOpen |format= |work= |accessdate=}}</ref>.
**[Indication 2]
*When considering surgery as an option, it is important to weigh the risks associated with the patient's underlying condition with the benefits of surgery<ref name="pmid16965557">{{cite journal |vauthors=Aryana A, Esterbrooks DJ, Morris PC |title=Nonbacterial thrombotic endocarditis with recurrent embolic events as manifestation of ovarian neoplasm |journal=J Gen Intern Med |volume=21 |issue=12 |pages=C12–5 |date=December 2006 |pmid=16965557 |pmc=1924740 |doi=10.1111/j.1525-1497.2006.00614.x |url=}}</ref>.
**[Indication 3]
*The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either:
**[Indication 1]
**[Indication 2]
**[Indication 3]
 
==Surgery==
 
*The feasibility of surgery depends on the stage of [malignancy] at diagnosis.
OR
*Surgery is the mainstay of treatment for [disease or malignancy].
Although not formally evaluated in prospective trials, surgical intervention for NBTE-associated vegetations has been reported and may be considered in select cases where the risk benefit is favorable [11,13,35]. The indications for surgery (vegetation excision or valve replacement) are the same as for infective endocarditis (eg, heart failure, acute valve rupture) but reports suggest that prevention of recurrent embolization is the most common reason for surgery. In contrast to infective endocarditis where complete removal of infected tissue is important, preservation of the valve may be possible in some cases of NBTE. Due to the high risk of recurrence, most case studies also report postoperative anticoagulation when feasible especially in those with a systemic reason for embolization (eg, antiphospholipid syndrome). When considering surgery, the benefits should be weighed against the risks in the context of the life expectancy from the underlying condition
==Contraindications==


==References==
==References==

Latest revision as of 21:09, 22 August 2020

non-bacterial thrombotic endocarditis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aisha Adigun, B.Sc., M.D.[2]

Overview

Surgery is not the first-line treatment option for patients with non-bacterial thrombotic endocarditis and is usually reserved for patients with either heart failure, acute valve rupture, or recurrence of thromboembolism despite adequate anticoagulation. It is important to weigh the risks associated with the patient's underlying condition with the benefits of surgery.

Indications

  • Surgery is not the first-line treatment option for patients with non-bacterial thrombotic endocarditis[1].
  • Surgery to replace or repair the valve is usually reserved for patients with either heart failure, acute valve rupture, or recurrence of thromboembolism despite adequate anticoagulation[2].
  • Mitral valve replacement surgery has an operative mortality of as high as 25% in patients with Libman-Sacks endocarditis.
  • The main reason for surgery in NBTE is the prevention of recurrent thromboembolism.
  • As opposed to infective endocarditis where the entire valve may need to be removed, valve preservation is possible in NBTE[3].
  • When considering surgery as an option, it is important to weigh the risks associated with the patient's underlying condition with the benefits of surgery[4].

References

  1. Roldan CA, Shively BK, Crawford MH (November 1996). "An echocardiographic study of valvular heart disease associated with systemic lupus erythematosus". N. Engl. J. Med. 335 (19): 1424–30. doi:10.1056/NEJM199611073351903. PMID 8875919.
  2. Rabinstein AA, Giovanelli C, Romano JG, Koch S, Forteza AM, Ricci M (March 2005). "Surgical treatment of nonbacterial thrombotic endocarditis presenting with stroke". J. Neurol. 252 (3): 352–5. doi:10.1007/s00415-005-0660-z. PMID 15726268.
  3. "Non-bacterial Thrombotic Endocarditis | IntechOpen".
  4. Aryana A, Esterbrooks DJ, Morris PC (December 2006). "Nonbacterial thrombotic endocarditis with recurrent embolic events as manifestation of ovarian neoplasm". J Gen Intern Med. 21 (12): C12–5. doi:10.1111/j.1525-1497.2006.00614.x. PMC 1924740. PMID 16965557.

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