Surgery valve replacement

Treatment of fungal IE is exceptionally difficult. There is a significant lack of studies to identify and recommend the most appropriate therapy. Currently, amphotericin B is the most common treatment. However, valve replacement surgery is often considered an adjunct therapy. Intravenous antifungal therapy requires high doses for a minimum of 8 weeks of treatment. Oral azoles (e.g., fluconazole) are used as long-term suppressive therapy to prevent relapse. The exact role of some... 

S. aureus has become more prevalent as a cause of endocarditis because of increased IV drug abuse, frequent use of peripheral and central venous catheters, and valve-replacement surgery. Coagulase-negative staphylococci (CNST, usually S. epidermidis) are prominent causes of PVE. 

Cardiopulmonary bypass, with extracorporeal circulation during cardiac artery bypass graft or heart valve replacement surgery, causes transient hemostatic defects in blood cells and perioperative bleeding. The protease inhibitor aprotinin (Trasylol) inhibits kalhkrein (coagulation phase) and plasmin (hbrinolysis) and protects platelets from mechanical injury. The overall effect after infusion is a decrease in bleeding. 

Although prosthetic heart valves have been extensively and successfully anployed clinically, problems still exist during the postoperative period concerning thromboembolism. Infection and valvular Incompetence. Infectious prosthetic valve endocarditis (PVE) remains as a serious and potentially devastating consequence of valve replacement surgery with mechanically fabricated... 

In the past, rheumatic heart disease was a prevalent risk factor for IE, but the incidence of this disease continues to decline. The risk of IE in persons with mitral valve prolapse and regurgitation is small however, because the condition is prevalent, it is an important contributor to the overall number of IE cases. Prosthetic valve endocarditis occurs in 1 % to 4% of patients undergoing valve replacement surgery. ... 

A 60-year-old woman taking digoxin, furosemide and warfarin (ESTR 3.5 to 5) developed a fever after mitral valve replacement surgery and was given rifampicin 450 mg twice daily and teicoplanin 400 mg twice daily. Within 3 days her ESTR began to fall and by day 6 the anticoagulant effect was completely lost. Despite progressive warfarin increases to 10, 15, and then 20 mg daily, her INR stayed between 1.2 and 1.6, even when the rifampicin was stopped, and remained low for a further 20 days, at whieh point the teicoplanin was also stopped. ... 

Briefing Document for the Circulatory Systems Device Panel Advisory Committee, 2011, The Edwards SAPIEN THV transcatheter heart valve system for patients with severe aortic stenosis who are not candidates for conventional open-heart aortic valve replacement surgery. Food Drug Administration, p. 300. 

Warfarin is the most commonly prescribed oral anticoagulant, with four million U.S. patients taking the drug for treatment and prevention of atrial fibrillation, stroke, deep vein thrombosis, or pulmonary embolism, and for those who have had heart valve replacement surgery. Adverse reactions to warfarin... 

Heart failure, chronic obstructive pulmonary disease, thyrotoxicosis, constrictive pericarditis, ischemic heart disease, sepsis, pulmonary embolus, rheumatic heart disease, hypertension, mitral stenosis, atrial irritation, or complication of coronary bypass or valve replacement surgery. 

Implantable valves, particularly mechanical valves which continue to encroach on tissue valves, are unique. Methods such as valvuloplasty, mitral valve repair, or use of ultrasound are unlikely to reduce the number of valve replacements into the twenty-first century. Valve selection remains in the hands of the surgeon because of the critical nature of the procedure. If anything goes wrong, the result can be catastrophic to the patient. Cost of a valve, from 3000— 4000, is a relatively small part of the cost of open-heart surgery which can mn as high as 30,000. Growth of the cardiovascular valve market has slowed in the United States with the decline of the threat of rheumatic fever. 

Surgical intervention has become an integral therapy in combination with pharmacologic management of IE. Valve replacement is the predominant intervention, and it is used in a minimum of 25% for all cases of IE.1 Surgery may be indicated if the patient has unresolved infection, ineffective antimicrobial therapy (often associated with fungal IE), more... 

Surgery is an important adjunct to management of endocarditis in certain patients. In most cases, valvectomy and valve replacement are performed to remove infected tissues and restore hemodynamic function. The most important indications for surgical intervention in the past have been heart failure in left-sided IE and persistent infections in right-sided IE. 

However, a number of prior studies had showed that 30% to 60% of patients who have an indication for aortic valve replacement do not undergo surgery due to advanced age, poor left ventricular function, prior... 

The nurse is discharging a client who has undergone surgery for a mechanical valve replacement. Which statement indicates the client needs more discharge teaching ... 

Heart valve replacements are considered among the most widely used cardiovascular devices. Traditional choices to the replacement surgeries are the mechanical and bio-prostheses. However, there are risks doing the surgeries, including thrombosis, infection, and limited valve durability. In recent years advances in polymer science have led to an important and new class of artificial heart valves made up of polyurethane-based... 

Key words textile valve prosthesis, percutaneous valve surgery, noninvasive valve replacement, trans-catheter heart valve, polyester fiber scaffold. 

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