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Prosthetic valve endocarditis (PVE) is a serious condition with high morbidity and mortality. This study investigated the association of surgical treatment with survival among patients with PVE. A retrospective cohort study was done of patients with PVE hospitalized over 8 years in a large referral center. Association of surgery with survival was evaluated with multivariable Cox proportional hazards regression, adjusting for propensity to be accepted for surgery, and analyzing surgery as a time-dependent covariate. Survival was also compared separately in a 1:1 propensity score-matched cohort of patients accepted for surgery and control patients consigned to nonsurgical treatment. Of 523 patients (mean [SD] age, 61 [14] years; 370 [71%] men; 393 [75%] initially accepted for surgery), 404 ultimately underwent surgery and 119 received nonsurgical treatment alone. Surgical treatment was associated with significantly lower hazard of death in the entire cohort (hazard ratio [HR] = 0.32; 95% confidence interval [CI]: 0.22-0.48; P <.001) and in the 1:1 matched cohort (HR = 0.33; 95% CI: 0.19-0.57; P <.001). Initial acceptance for surgery was associated with significantly lower odds of in-hospital death (odds ratio [OR] = 0.26; 95% CI: 0.11-0.59; P <.001), death or readmission within 90 days (OR = 0.17; 95% CI: 0.07-0.43; P <.001), and death within 1 year (OR = 0.16; 95% CI: 0.08-0.34; P <.001). Surgical treatment is associated with a large survival benefit in PVE. A decision to pursue nonsurgical treatment in PVE should entail close follow-up for any development of an indication for surgery. [ABSTRACT FROM AUTHOR]

The current study reports PIV (particle image velocimetry) analysis of the transparent and opaque flow using a smartphone camera in ambient light. A typical PIV setup consists of high-speed cameras, synchronizers, and high-energy light sources like pulsed lasers or high-power LEDs, whereas in the present work, we demonstrate that PIV analysis can be possible without sophisticated instruments. Two essential parameters, viz recording speed and interrogation window size, have been optimized for the flow recorded in the mobile camera. The present work describes methods for optimization of recording speed (fps-frames per second) and interrogation window (IW) size for the transparent (water) vortex flow. Further, the velocity profile derived at optimal recording speed and interrogation window size using the PIV analysis have been compared with the Burger vortex model to validate the optimization methods and the parameters. The agreement validates the optimization methods and the parameters. Moreover, the optimized parameters have been used to record and analyze the opaque flow to extend the application potentiality. The finding suggests that the PIV- extracted data of the opaque flow can be compared with the transparent flow, which suggests that PIV can also be used to analyze opaque flow. [Display omitted] • Velocity estimation and comparison of transparent and opaque flow using PIV. • The potential of the PIV technique for the surface flow analysis of opaque flow. • The use of ambient light and a smartphone camera to record the flow. • The study provides a stepwise optimization method for consideration of recording speed and interrogation window size. [ABSTRACT FROM AUTHOR]

Background Rifampin is recommended as adjunctive treatment for staphylococcal prosthetic valve endocarditis (PVE). It is unclear whether this should hold for surgically treated patients. The purpose of this study was to examine whether adjunctive rifampin treatment in addition to cell wall active antimicrobial agents in patients with surgically treated staphylococcal infective endocarditis (IE) results in better outcomes. Methods Patients operated on for staphylococcal IE from April 1, 2008, to July 1, 2014, were identified from our institution’s IE registry. Rifampin treatment was defined as 3 or more days of rifampin postoperatively. Cox proportional hazards regression was used to compare a composite outcome of death or reoperation for IE relapse, between patients treated and not treated with rifampin, adjusted for propensity to be treated with rifampin, methicillin resistance, all-purpose refined diagnosis related group (APR-DRG) severity score, and APR-DRG mortality risk. Results In all, 273 patients were identified. The mean age was 56 years, 66% were male, 50% had PVE, 60% had S. aureus or S. lugdunensis infection, 89% had left side involvement, and 57% had invasive disease. Fifty-one (27%) received 3 or more days of rifampin postoperatively. Ninety-two patients died or underwent reoperation for IE relapse at a median of 205 days (interquartile range 56 to 718 days). In a multivariable model, patients treated with rifampin had a similar hazard of death or reoperation for IE relapse as those not treated (hazard ratio 0.76, 95% confidence interval 0.44 to 1.32, p value 0.34). The results were robust to varying definitions of rifampin treatment. Conclusions Among patients with surgically treated staphylococcal IE there was insufficient evidence to claim a reoperation-free survival benefit from treatment with rifampin. Rifampin should not be used as adjunctive therapy for staphylococcal IE in patients who have undergone surgical procedures for its treatment. [ABSTRACT FROM AUTHOR]

Paravalvular leak (PVL) is often seen after aortic (AV) and mitral valve (MV) surgery, either due to infection or valve dehiscence. We sought to describe predictors of longer-term outcomes in patients who developed PVL after AV and MV surgery and were considered eligible for reoperative cardiac surgery (RCS). We studied 495 such patients (65 ± 14 years, 65% men, 47% with MV PVL) who presented at our center between January 2003 and December 2011. Patients with severe mitral/aortic stenosis, patients with less than mild PVL, and those with prohibitive risk precluding RCS were excluded. Society of Thoracic Surgeons (STS) score was calculated. Primary endpoint was mortality. At baseline, mean STS score and left ventricular ejection fraction were 5.8 ± 4% and 52 ± 12%, respectively. In total, 105 (21%) had infective PVL and 72% had moderate or greater PVL. At a median of 8 days, 351 (71%) patients underwent RCS to repair PVL (3% in-hospital postoperative mortality), and at 6.6 ± 4 years, 230 (47%) patients died. On multivariable Cox survival analysis, greater STS score (hazard ratio or HR 1.35), mitral versus aortic PVL (HR 1.66), infectious etiology (HR 2.05), and greater right ventricular systolic pressure (HR 1.09) were associated with greater longer-term mortality, whereas surgery (HR 0.58) was associated with improved longer-term survival (all P <.05). Patients who develop mild or greater PVL after AV/MV surgery have a high rate of longer-term mortality, despite excellent perioperative outcomes. Greater STS score, right ventricular systolic pressure, infectious etiology, and MV (vs AV) involvement were all independently associated with long-term mortality, whereas RCS for PVL closure was associated with improved longer-term survival. [ABSTRACT FROM AUTHOR]