Part of the book: Vascular Surgery
Infective endocarditis is a rare but life-threatening disease that has a major impact on healthcare resources. It is heterogeneous in etiology, clinical manifestations, and course. The timing of surgery remains a topic of debate. Some authors promote an early surgical approach to improve the outcomes. There are different points of view between American and European guidelines regarding the relative priority of surgery over medical treatment. Anyway, multidisciplinary teams and multimodality strategies are advocated in order to optimize the treatment according to the individual needs of the patients. The early surgical approach may represent a valuable treatment option for high-risk patients. In this chapter, we discuss the latest evidence on surgical approaches, potential pitfalls, and the controversial issues in the contemporary practice of infective endocarditis.
Part of the book: Endocarditis
Emergent surgical repair of thoracic acute aortic dissection (TAAD) aims to prevent potentially lethal complications including cardiac tamponade, neurological damage, acute aortic valve dysfunction, rupture of the aortic wall into the pericardial space, or myocardial infarction due to the dissection of the coronary ostia. Furthermore, the progression of the dissection involving peripheral arteries with, consequently, a possible preoperative multiple-organ malperfusion can lead to a drastic increase in operative risk. In fact, even with prompt surgical treatment, TAAD continues to be associated with an in-hospital mortality rate of 20–30%, and malperfusion of various organ systems can dramatically increase the operative mortality. From the analysis of the various pre- and perioperative risk factors, it is possible to evaluate the real operative risk and establish in which patients emergency surgery continues to offer a substantial prognostic benefit in comparison with medical therapy only and in which surgery, on the contrary, may not offer any prognostic advantage.
Part of the book: Advances in Vascular Surgery [Working title]