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Infective endocarditis: To operate or not to operate?
International Journal of Cardiology 135 (2009) 1 – 3 www.elsevier.com/locate/ijcard
Editorial
Infective endocarditis: To operate or not to operate? That's a question that is still unresolved Tsung O. Cheng ⁎ Department of Medicine, The George Washington University Medical Center, 2150 Pennsylvania Avenue, N.W., Washington, D.C. 20037, United States Received 1 December 2008; accepted 1 December 2008 Available online 14 January 2009
Infective endocarditis is a serious disease with increasing incidence throughout the world in recent years, especially among the elderly [1–15]. The two commonest predisposing factors used to be rheumatic valvular disease and congenital heart disease. With effective eradication of rheumatic fever and consequent decrease of rheumatic heart disease [16] and early total correction of most congenital heart defects, other predisposing factors have emerged, such as intravenous drug use, prosthetic heart valves, degenerative valve sclerosis and increasing use of medical and surgical devices for both diagnostic and therapeutic purposes [1,3,6–8,10–12,14,17– 22]. Another reason is the increasing incidence of diabetes around the world [23,24]. Diabetics are more vulnerable to infective endocarditis than non-diabetics [2,4,9,17]. The poor prognosis for patients with infective endocarditis is due not only to significant morbidity and mortality in the acute phase during hospitalization but also to late complications that may occur after the infection has been controlled. The need for surgical intervention is a frequent issue that needs to be addressed either before or after the patient has been discharged. The recent report from Spain [25] that concluded that survival was similar for patients who underwent surgery during hospitalization and those who did not raise anew the important question of indications for surgery in infective endocarditis. There are just as many studies that reported benefits of surgery [26–34] as those that found surgery during hospitalization not a predictor of reduced long-term mortality in patients with infective endocarditis [25,35–40]. A ⁎ Tel.: +1 202 741 2426; fax: +1 202 741 2324. E-mail address: [email protected]. 0167-5273/$ - see front matter © 2008 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijcard.2008.12.010
thorough review of the current literature combined with my personal experience over six decades of clinical practice led me to reach the following conclusions. Indications for surgery include: 1. 2. 3. 4. 5. 6. 7. 8.
Uncontrolled congestive heart failure, Persistent bacteremia, Ineffective antimicrobial therapy such as fungal endocarditis, Recurrent embolization, Resection of mycotic aneurysm or myocardial abscess, Prosthetic valve endocarditis (in most cases), Valve dysfunction on fluoroscopy, Large (N 10 mm diameter) hypermobile vegetation on echocardiography, 9. Tricuspid valve endocarditis in intravenous drug addict (tricuspid valvectomy [41]). Contraindications for surgery include: 1. 2. 3. 4.
Recalcitrant intravenous drug abuse, Noncompliance with anticoagulant therapy, Lack of experienced surgical team, Other significant co-morbidities including serious sequelae from cerebral embolization.
Because infective endocarditis is such a serious disease and because the decision to operate or not to operate is still an unresolved issue [42], efforts should be directed at prevention rather than treatment. The guidelines for endocarditis prophylaxis have changed several times during the last 15 years. Unfortunately, the most recent recommendations of the American Heart Association for endocarditis
2
T.O. Cheng / International Journal of Cardiology 135 (2009) 1–3
prophylaxis have become a rather controversial issue [43]. For example, prophylaxis against infective endocarditis is no longer recommended for all patients with mitral valve prolapse [44,45]. As I mentioned previously [43], the benefits of chemoprophylaxis far outweigh the disadvantages. The benefits are: (1) it is efficacious; (2) it is cost-effective; and (3) it is simple to do. The only possible disadvantage of chemoprophylaxis is risk of adverse reactions such as fatal anaphylaxis. “For 50 years, the AHA has recommended a penicillin as the preferred choice for dental prophylaxis for IE. During these 50 years, the Committee is unaware of any cases reported to the AHA of fatal anaphylaxis resulting from the administration of a penicillin recommended in the AHA guidelines for IE prophylaxis. The Committee believes that a single dose of amoxicillin or ampicillin is safe and is the preferred prophylactic agent for individuals who do not have a history of type 1 hypersensitivity reaction to a penicillin, such as anaphylaxis, urticaria, or angioedema.” [44, pp. 1743–4]. Infective endocarditis is a devastating disease; many of the patients end up with prosthetic valve replacement, which makes them even more susceptible to recurrent infective endocarditis. Because the question of surgery for infective endocarditis is still unresolved, it is far more prudent to
Fig. 1. A quotation from the Yellow Emperor's Canon of Internal Medicine (Huang Di Neijin). Chinese calligraphy (top) by Madame Ge Qiyun, wife of Han Xu, Chinese Ambassador to the United States, with English translation (bottom).
prevent than to treat infective endocarditis. As the Yellow Emperor of China said thousands of years ago, “The superior doctor prevents diseases; the mediocre doctor attends to impending diseases; the inferior doctor treats full-blown diseases” (Fig. 1). It is far better and easier to prevent than to treat a disease. So, let us all be superior doctors rather than inferior doctors! Acknowledgement The author of this manuscript has certified that he complied with the Principles of Ethical Publishing in the International Journal of Cardiology [46]. References [1] Casabė JH. Infective endocarditis. A changing disease. Medicina (B Aires) 2008;68:164–74. [2] Movahed MR, Hashemzadeh M, Jamal MM. Increased prevalence of infectious endocarditis in patients with type II diabetes mellitus. J Diabetes Complications 2007;21:403–6. [3] Cooper HL, Brady JE, Ciccarone D, Tempalski B, Gostnell K, Friedman SR. Nationwide increase in the number of hospitalizations for illicit injection drug use-related infective endocarditis. Clin Infect Dis 2007;45:1200–3. [4] Lee CH, Tsai WC, Liu PY, et al. Epidemiologic features of infective endocarditis in Taiwanese adults involving native valves. Am J Cardiol 2007;100:1282–5. [5] Tleyjeh IM, Abdel-Latif A, Rahbi H, et al. A systematic review of population-based studies of infective endocarditis. Chest 2007;132:1025–35. [6] Abrutyn E, Cabell CH, Fowler VG, et al. Medical treatment of endocarditis. Curr Infect Dis Rep 2007;9:271–82. [7] Hoen B. Epidemiology and antibiotic treatment of infective endocarditis: an update. Heart 2006;92:1694–700. [8] Prendergast BD. The changing face of infective endocarditis. Heart 2006;92:879–85. [9] Walpot J, Blok W, van Zwienen J, Klazen C, Amsel B. Incidence and complication rate of infective endocarditis in the Dutch region of Walcheren: a 3-year retrospective study. Acta Cardiol 2006;61:175–81. [10] Bashore TM, Cabell C, Fowler Jr V. Update on infective endocarditis. Curr Probl Cardiol 2006;31:274–352. [11] Ferreiros E, Nacinovich F, Casabé JH, et al. Epidemiologic, clinical, and microbiologic profile of infective endocarditis in Argentina: a national survey. The Endocarditis Infecciosa en la República. Argentina-2 (EIRA-2) Study. Am Heart J 2006;1551:545–52. [12] Moreillon P, Que YA. Infective endocarditis. Lancet 2004;363:139–49. [13] Chen HZ, Fan WH, Jin XJ, Wang Q, Zhou J, Shi ZY. Changing trends of etiologic characteristics of cardiovascular disease among inpatients in Shanghai: a retrospective observational study from 1948 to 1999. Zhonghua Neike Zazhi Chin J Intern Med 2003;42:829–32. [14] Cheng A, Athan E, Appelbe A, McDonald M. The changing profile of bacterial endocarditis as seen at an Australian provincial centre. Heart Lung Circ 2002;11:26–31. [15] Hogevik H, Olaison L, Andersson R, Lindberg J, Alestig K. Epidemiologic aspects of infective endocarditis in an urban population. A 5-year prospective study. Medicine 1995;74:324–39. [16] Cheng TO. How much of the recent decline in rheumatic heart disease in China can be explained by changes in cardiovascular risk factors? Int J Cardiol 2009;132:300–2. [17] Durante-Mangoni E, Bradley S, Selton-Suty C, et al. Current features of infective endocarditis in elderly patients: results of the International Collaboration on Endocarditis Prospective Cohort Study. Arch Intern Med 2008;168:2095–103.
T.O. Cheng / International Journal of Cardiology 135 (2009) 1–3 [18] Siegman-Igra Y, Koifman B, Porat R, Porat D, Giladi M. Healthcare associated infective endocarditis: a distinct entity. Scand J Infect Dis 2008;40:474–80. [19] Fernández-Hidalgo N, Almirante B, Tornos P, et al. Contemporary epidemiology and prognosis of health care-associated infective endocarditis. Clin Infect Dis 2008;47:1287–97. [20] Winston LG, Bolger AF. Modern epidemiology, prophylaxis, and diagnosis and therapy for infective endocarditis. Curr Cardiol Rep 2006;8:102–8. [21] Baddley JW, Benjamin Jr DK, Patel M, et al. Candida infective endocarditis. Eur J Clin Microbiol Infect Dis 2008;27:519–29. [22] Brown PD. Surgery for infective endocarditis. Curr Infect Dis Rep 2007;9:291-196. [23] Cheng TO. Diabetes and obesity epidemics in China: a national crisis. Int J Cardiol 2007;123:1–2. [24] Yang WY. Mission: halt diabetes momentum and stop growing epidemic. Chin Med J 2008;121:2115–8. [25] Martínez-Sellés M, Muñoz P, Estevez A, et al. Long-term outcome of infective endocarditis in non-intravenous drug users. Mayo Clin Proc 2008;83:1213–7. [26] Vikram HR, Buenconsejo J, Hasbun R, Quagliarello VJ. Impact of valve surgery on 6-month mortality in adults with complicated, left-sided native valve endocarditis. A propensity analysis. JAMA 2003;290:3207–14. [27] Karth GD, Koreny M, Binder T, et al. Complicated infective endocarditis necessitating ICU admission: clinical course and prognosis. Crit Care 2002;6:149–54. [28] Knosalla C, Weng Y, Yankah AC, et al. Surgical treatment of active infective aortic valve endocarditis with associated periannular abscess — 11 year results. Eur Heart J 2000;21:490–7. [29] Choussat R, Thomas D, Isnard R, et al. Perivalvular abscesses associated with endocarditis; clinical features and prognostic factors of overall survival in a series of 233 cases. Perivalvular Abscesses French Multicentre Study. Eur Heart J 1999;20:232–41. [30] Middlemost S, Wisenbaugh T, Meyerowitz C, et al. A case for early surgery in native left-sided endocarditis complicated by heart failure: results in 203 patients. J Am Coll Cardiol 1991;18:663–7. [31] Vlessis AA, Hovaguimian H, Jaggers J, Ahmad A, Starr A. Infective endocarditis: ten-year review of medical and surgical therapy. Ann Thorac Surg 1996;61:1217–22. [32] Young JB, Welton DE, Raizner AE, et al. Surgery in active infective endocarditis. Circulation 1979;60:77–81. [33] Richardson JV, Karp RB, Kirklin JW, Dismukes WE. Treatment of infective endocarditis: a 10-year comparative analysis. Circulation 1978;58:589–97.
3
[34] Cabell CH, Wang A. Current treatment options for patients with endocarditis: the evolving indications for cardiac surgery. Curr Treat Options Cardiovasc Med 2004;6:441–9. [35] Tran CT, Kjeldsen K. Endocarditis at a tertiary hospital: reduced acute mortality but poor long term prognosis. Scand J Infect Dis 2006;38:664–70. [36] Cabell CH, Abrutyn E, Fowler Jr VG, et al. Use of surgery in patients with native valve infective endocarditis: results from the International Collaboration on Endocarditis Merged Database. Am Heart J 2005;150:1092–8. [37] Tornos P, Iung B, Permanyer-Miralda G, et al. Infective endocarditis in Europe: lessons from the Euro heart survey. Heart 2005;91:571–5. [38] Tornos P. Management of prosthetic valve endocarditis: a clinical challenge. Heart 2003;89:245–6. [39] Castillo JC, Anguita MP, Ramirez A, et al. Long term outcome of infective endocarditis in patients who were not drug addicts: a 10 year study. Heart 2000;83:525–30. [40] Delahaye JP, Malquarti V, Saradarian W, et al. Prognosis of surgically treated infectious endocarditis. Arch Mal Coeur Vaiss 1987;80:302–9. [41] Cheng TO. Cardiovascular complications. In: Pradhan SN, Dutta SN, editors. Drug abuse: clinical and basic aspects. St. Louis: CV Mosby; 1977. p. 388–99. [42] O'Gara PT. Infective endocarditis 2006: indications for surgery. Trans Am Clin Climatol Assoc 2007;118:187–98. [43] Cheng TO. Endocarditis prophylaxis in patients with mitral valve prolapse remains a controversial issue despite the new American Heart Association guidelines. Int J Cardiol 2008;127:149–50. [44] Wilson W, Taubert KA, Gewitz M, et al. Prevention of infective endocarditis. Guidelines from the American Heart Association. A guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation 2007;116:1736–54. [45] Nishimura RA, Carabello A, Faxon DP, et al. ACC/AHA 2008 guideline update on valvular heart disease: focused update on infective endocarditis: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2008;118:887–96. [46] Coats AJ. Ethical authorship and publishing. Int J Cardiol 2009;131: 149–50.
Editorial
Infective endocarditis: To operate or not to operate? That's a question that is still unresolved Tsung O. Cheng ⁎ Department of Medicine, The George Washington University Medical Center, 2150 Pennsylvania Avenue, N.W., Washington, D.C. 20037, United States Received 1 December 2008; accepted 1 December 2008 Available online 14 January 2009
Infective endocarditis is a serious disease with increasing incidence throughout the world in recent years, especially among the elderly [1–15]. The two commonest predisposing factors used to be rheumatic valvular disease and congenital heart disease. With effective eradication of rheumatic fever and consequent decrease of rheumatic heart disease [16] and early total correction of most congenital heart defects, other predisposing factors have emerged, such as intravenous drug use, prosthetic heart valves, degenerative valve sclerosis and increasing use of medical and surgical devices for both diagnostic and therapeutic purposes [1,3,6–8,10–12,14,17– 22]. Another reason is the increasing incidence of diabetes around the world [23,24]. Diabetics are more vulnerable to infective endocarditis than non-diabetics [2,4,9,17]. The poor prognosis for patients with infective endocarditis is due not only to significant morbidity and mortality in the acute phase during hospitalization but also to late complications that may occur after the infection has been controlled. The need for surgical intervention is a frequent issue that needs to be addressed either before or after the patient has been discharged. The recent report from Spain [25] that concluded that survival was similar for patients who underwent surgery during hospitalization and those who did not raise anew the important question of indications for surgery in infective endocarditis. There are just as many studies that reported benefits of surgery [26–34] as those that found surgery during hospitalization not a predictor of reduced long-term mortality in patients with infective endocarditis [25,35–40]. A ⁎ Tel.: +1 202 741 2426; fax: +1 202 741 2324. E-mail address: [email protected]. 0167-5273/$ - see front matter © 2008 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijcard.2008.12.010
thorough review of the current literature combined with my personal experience over six decades of clinical practice led me to reach the following conclusions. Indications for surgery include: 1. 2. 3. 4. 5. 6. 7. 8.
Uncontrolled congestive heart failure, Persistent bacteremia, Ineffective antimicrobial therapy such as fungal endocarditis, Recurrent embolization, Resection of mycotic aneurysm or myocardial abscess, Prosthetic valve endocarditis (in most cases), Valve dysfunction on fluoroscopy, Large (N 10 mm diameter) hypermobile vegetation on echocardiography, 9. Tricuspid valve endocarditis in intravenous drug addict (tricuspid valvectomy [41]). Contraindications for surgery include: 1. 2. 3. 4.
Recalcitrant intravenous drug abuse, Noncompliance with anticoagulant therapy, Lack of experienced surgical team, Other significant co-morbidities including serious sequelae from cerebral embolization.
Because infective endocarditis is such a serious disease and because the decision to operate or not to operate is still an unresolved issue [42], efforts should be directed at prevention rather than treatment. The guidelines for endocarditis prophylaxis have changed several times during the last 15 years. Unfortunately, the most recent recommendations of the American Heart Association for endocarditis
2
T.O. Cheng / International Journal of Cardiology 135 (2009) 1–3
prophylaxis have become a rather controversial issue [43]. For example, prophylaxis against infective endocarditis is no longer recommended for all patients with mitral valve prolapse [44,45]. As I mentioned previously [43], the benefits of chemoprophylaxis far outweigh the disadvantages. The benefits are: (1) it is efficacious; (2) it is cost-effective; and (3) it is simple to do. The only possible disadvantage of chemoprophylaxis is risk of adverse reactions such as fatal anaphylaxis. “For 50 years, the AHA has recommended a penicillin as the preferred choice for dental prophylaxis for IE. During these 50 years, the Committee is unaware of any cases reported to the AHA of fatal anaphylaxis resulting from the administration of a penicillin recommended in the AHA guidelines for IE prophylaxis. The Committee believes that a single dose of amoxicillin or ampicillin is safe and is the preferred prophylactic agent for individuals who do not have a history of type 1 hypersensitivity reaction to a penicillin, such as anaphylaxis, urticaria, or angioedema.” [44, pp. 1743–4]. Infective endocarditis is a devastating disease; many of the patients end up with prosthetic valve replacement, which makes them even more susceptible to recurrent infective endocarditis. Because the question of surgery for infective endocarditis is still unresolved, it is far more prudent to
Fig. 1. A quotation from the Yellow Emperor's Canon of Internal Medicine (Huang Di Neijin). Chinese calligraphy (top) by Madame Ge Qiyun, wife of Han Xu, Chinese Ambassador to the United States, with English translation (bottom).
prevent than to treat infective endocarditis. As the Yellow Emperor of China said thousands of years ago, “The superior doctor prevents diseases; the mediocre doctor attends to impending diseases; the inferior doctor treats full-blown diseases” (Fig. 1). It is far better and easier to prevent than to treat a disease. So, let us all be superior doctors rather than inferior doctors! Acknowledgement The author of this manuscript has certified that he complied with the Principles of Ethical Publishing in the International Journal of Cardiology [46]. References [1] Casabė JH. Infective endocarditis. A changing disease. Medicina (B Aires) 2008;68:164–74. [2] Movahed MR, Hashemzadeh M, Jamal MM. Increased prevalence of infectious endocarditis in patients with type II diabetes mellitus. J Diabetes Complications 2007;21:403–6. [3] Cooper HL, Brady JE, Ciccarone D, Tempalski B, Gostnell K, Friedman SR. Nationwide increase in the number of hospitalizations for illicit injection drug use-related infective endocarditis. Clin Infect Dis 2007;45:1200–3. [4] Lee CH, Tsai WC, Liu PY, et al. Epidemiologic features of infective endocarditis in Taiwanese adults involving native valves. Am J Cardiol 2007;100:1282–5. [5] Tleyjeh IM, Abdel-Latif A, Rahbi H, et al. A systematic review of population-based studies of infective endocarditis. Chest 2007;132:1025–35. [6] Abrutyn E, Cabell CH, Fowler VG, et al. Medical treatment of endocarditis. Curr Infect Dis Rep 2007;9:271–82. [7] Hoen B. Epidemiology and antibiotic treatment of infective endocarditis: an update. Heart 2006;92:1694–700. [8] Prendergast BD. The changing face of infective endocarditis. Heart 2006;92:879–85. [9] Walpot J, Blok W, van Zwienen J, Klazen C, Amsel B. Incidence and complication rate of infective endocarditis in the Dutch region of Walcheren: a 3-year retrospective study. Acta Cardiol 2006;61:175–81. [10] Bashore TM, Cabell C, Fowler Jr V. Update on infective endocarditis. Curr Probl Cardiol 2006;31:274–352. [11] Ferreiros E, Nacinovich F, Casabé JH, et al. Epidemiologic, clinical, and microbiologic profile of infective endocarditis in Argentina: a national survey. The Endocarditis Infecciosa en la República. Argentina-2 (EIRA-2) Study. Am Heart J 2006;1551:545–52. [12] Moreillon P, Que YA. Infective endocarditis. Lancet 2004;363:139–49. [13] Chen HZ, Fan WH, Jin XJ, Wang Q, Zhou J, Shi ZY. Changing trends of etiologic characteristics of cardiovascular disease among inpatients in Shanghai: a retrospective observational study from 1948 to 1999. Zhonghua Neike Zazhi Chin J Intern Med 2003;42:829–32. [14] Cheng A, Athan E, Appelbe A, McDonald M. The changing profile of bacterial endocarditis as seen at an Australian provincial centre. Heart Lung Circ 2002;11:26–31. [15] Hogevik H, Olaison L, Andersson R, Lindberg J, Alestig K. Epidemiologic aspects of infective endocarditis in an urban population. A 5-year prospective study. Medicine 1995;74:324–39. [16] Cheng TO. How much of the recent decline in rheumatic heart disease in China can be explained by changes in cardiovascular risk factors? Int J Cardiol 2009;132:300–2. [17] Durante-Mangoni E, Bradley S, Selton-Suty C, et al. Current features of infective endocarditis in elderly patients: results of the International Collaboration on Endocarditis Prospective Cohort Study. Arch Intern Med 2008;168:2095–103.
T.O. Cheng / International Journal of Cardiology 135 (2009) 1–3 [18] Siegman-Igra Y, Koifman B, Porat R, Porat D, Giladi M. Healthcare associated infective endocarditis: a distinct entity. Scand J Infect Dis 2008;40:474–80. [19] Fernández-Hidalgo N, Almirante B, Tornos P, et al. Contemporary epidemiology and prognosis of health care-associated infective endocarditis. Clin Infect Dis 2008;47:1287–97. [20] Winston LG, Bolger AF. Modern epidemiology, prophylaxis, and diagnosis and therapy for infective endocarditis. Curr Cardiol Rep 2006;8:102–8. [21] Baddley JW, Benjamin Jr DK, Patel M, et al. Candida infective endocarditis. Eur J Clin Microbiol Infect Dis 2008;27:519–29. [22] Brown PD. Surgery for infective endocarditis. Curr Infect Dis Rep 2007;9:291-196. [23] Cheng TO. Diabetes and obesity epidemics in China: a national crisis. Int J Cardiol 2007;123:1–2. [24] Yang WY. Mission: halt diabetes momentum and stop growing epidemic. Chin Med J 2008;121:2115–8. [25] Martínez-Sellés M, Muñoz P, Estevez A, et al. Long-term outcome of infective endocarditis in non-intravenous drug users. Mayo Clin Proc 2008;83:1213–7. [26] Vikram HR, Buenconsejo J, Hasbun R, Quagliarello VJ. Impact of valve surgery on 6-month mortality in adults with complicated, left-sided native valve endocarditis. A propensity analysis. JAMA 2003;290:3207–14. [27] Karth GD, Koreny M, Binder T, et al. Complicated infective endocarditis necessitating ICU admission: clinical course and prognosis. Crit Care 2002;6:149–54. [28] Knosalla C, Weng Y, Yankah AC, et al. Surgical treatment of active infective aortic valve endocarditis with associated periannular abscess — 11 year results. Eur Heart J 2000;21:490–7. [29] Choussat R, Thomas D, Isnard R, et al. Perivalvular abscesses associated with endocarditis; clinical features and prognostic factors of overall survival in a series of 233 cases. Perivalvular Abscesses French Multicentre Study. Eur Heart J 1999;20:232–41. [30] Middlemost S, Wisenbaugh T, Meyerowitz C, et al. A case for early surgery in native left-sided endocarditis complicated by heart failure: results in 203 patients. J Am Coll Cardiol 1991;18:663–7. [31] Vlessis AA, Hovaguimian H, Jaggers J, Ahmad A, Starr A. Infective endocarditis: ten-year review of medical and surgical therapy. Ann Thorac Surg 1996;61:1217–22. [32] Young JB, Welton DE, Raizner AE, et al. Surgery in active infective endocarditis. Circulation 1979;60:77–81. [33] Richardson JV, Karp RB, Kirklin JW, Dismukes WE. Treatment of infective endocarditis: a 10-year comparative analysis. Circulation 1978;58:589–97.
3
[34] Cabell CH, Wang A. Current treatment options for patients with endocarditis: the evolving indications for cardiac surgery. Curr Treat Options Cardiovasc Med 2004;6:441–9. [35] Tran CT, Kjeldsen K. Endocarditis at a tertiary hospital: reduced acute mortality but poor long term prognosis. Scand J Infect Dis 2006;38:664–70. [36] Cabell CH, Abrutyn E, Fowler Jr VG, et al. Use of surgery in patients with native valve infective endocarditis: results from the International Collaboration on Endocarditis Merged Database. Am Heart J 2005;150:1092–8. [37] Tornos P, Iung B, Permanyer-Miralda G, et al. Infective endocarditis in Europe: lessons from the Euro heart survey. Heart 2005;91:571–5. [38] Tornos P. Management of prosthetic valve endocarditis: a clinical challenge. Heart 2003;89:245–6. [39] Castillo JC, Anguita MP, Ramirez A, et al. Long term outcome of infective endocarditis in patients who were not drug addicts: a 10 year study. Heart 2000;83:525–30. [40] Delahaye JP, Malquarti V, Saradarian W, et al. Prognosis of surgically treated infectious endocarditis. Arch Mal Coeur Vaiss 1987;80:302–9. [41] Cheng TO. Cardiovascular complications. In: Pradhan SN, Dutta SN, editors. Drug abuse: clinical and basic aspects. St. Louis: CV Mosby; 1977. p. 388–99. [42] O'Gara PT. Infective endocarditis 2006: indications for surgery. Trans Am Clin Climatol Assoc 2007;118:187–98. [43] Cheng TO. Endocarditis prophylaxis in patients with mitral valve prolapse remains a controversial issue despite the new American Heart Association guidelines. Int J Cardiol 2008;127:149–50. [44] Wilson W, Taubert KA, Gewitz M, et al. Prevention of infective endocarditis. Guidelines from the American Heart Association. A guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation 2007;116:1736–54. [45] Nishimura RA, Carabello A, Faxon DP, et al. ACC/AHA 2008 guideline update on valvular heart disease: focused update on infective endocarditis: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2008;118:887–96. [46] Coats AJ. Ethical authorship and publishing. Int J Cardiol 2009;131: 149–50.