Bernard D Prendergast

Publications of Bernard D Prendergast

• ESC Working Group on Valvular Heart Disease Position Paper: assessing the risk of interventions in patients with valvular heart disease.

  Authors: Raphael Rosenhek, Bernard Iung, Pilar Tornos, Manuel J Antunes, Bernard D Prendergast, Catherine M Otto, Arie Pieter Kappetein, Janina Stepinska, Jens J Kaden, Christoph K Naber, Esmeray Acartürk, Christa Gohlke-Bärwolf

  European heart journal. 03/2011;

  Aims Risk scores provide an important contribution to clinical decision-making, but their validity has been questioned in patients with valvular heart disease (VHD), since current scores have beenAims Risk scores provide an important contribution to clinical decision-making, but their validity has been questioned in patients with valvular heart disease (VHD), since current scores have been mainly derived and validated in adults undergoing coronary bypass surgery. The Working Group on Valvular Heart Disease of the European Society of Cardiology reviewed the performance of currently available scores when applied to VHD, in order to guide clinical practice and future development of new scores. Methods and results The most widely used risk scores (EuroSCORE, STS, and Ambler score) were reviewed, analysing variables included and their predictive ability when applied to patients with VHD. These scores provide relatively good discrimination, i.e. a gross estimation of risk category, but cannot be used to estimate the exact operative mortality in an individual patient because of unsatisfactory calibration. Conclusion Current risk scores do not provide a reliable estimate of exact operative mortality in an individual patient with VHD. They should therefore be interpreted with caution and only used as part of an integrated approach, which incorporates other patient characteristics, the clinical context, and local outcome data. Future risk scores should include additional variables, such as cognitive and functional capacity and be prospectively validated in high-risk patients. Specific risk models should also be developed for newer interventions, such as transcatheter aortic valve implantation.

• Resistant pericardial tamponade.

  Authors: Florim Cuculi, James D Newton, Adrian P Banning, Bernard D Prendergast

  Circulation. 02/2011; 123(5):566-7.

• Surgery for infective endocarditis: who and when?

  Authors: Bernard D Prendergast, Pilar Tornos

  Circulation. 03/2010; 121(9):1141-52.

• The European Society of Cardiology 2009 guidelines on the prevention, diagnosis, and treatment of infective endocarditis: key messages for clinical practice.

  Authors: James L Harrison, Bernard D Prendergast, Gilbert Habib

  Polskie archiwum medycyny wewnȩtrznej. 12/2009; 119(12):773-6.

• Antibiotic prophylaxis for infective endocarditis.

  Authors: James L Harrison, Bruno Hoen, Bernard D Prendergast

  Lancet. 05/2008; 371(9621):1317-9.

• Community-associated MRSA (CA-MRSA): an emerging pathogen in infective endocarditis.

  Authors: B Cherie Millar, Bernard D Prendergast, John E Moore

  The Journal of antimicrobial chemotherapy. 02/2008; 61(1):1-7.

  Over the last decade, a novel methicillin-resistant Staphylococcus aureus (MRSA) has emerged, primarily associated with healthy individuals within the community. This organism is distinct fromOver the last decade, a novel methicillin-resistant Staphylococcus aureus (MRSA) has emerged, primarily associated with healthy individuals within the community. This organism is distinct from healthcare-associated MRSA (HA-MRSA) in terms of epidemiology, microbiology and clinical manifestation and as such has been defined as community-associated MRSA (CA-MRSA). Given that S. aureus is a major aetiological agent of infective endocarditis (IE), particularly associated with the iv drug user population, reports of IE attributed to CA-MRSA are now emerging in the literature. The aims of this article are to (i) define and contrast CA-MRSA with HA-MRSA; (ii) review the published cases of CA-MRSA IE to date; and (iii) evaluate the current international recommendations for antibiotic prophylaxis and treatment regimens for IE in relation to CA-MRSA.

• Infective endocarditis.

  Authors: Rhys P Beynon, V K Bahl, Bernard D Prendergast

  BMJ (Clinical research ed.). 09/2006; 333(7563):334-9.

• Management of patients with prosthetic heart valves during non-cardiac surgery.

  Authors: Bernard D Prendergast

  Przegla̧d lekarski. 02/2004; 61(6):556-9.

  Non-cardiac surgery in patients with prosthetic heart valves poses the particular hazards of infective endocarditis, increased bleeding risk and the possibility of acute/subacute valve thrombosis orNon-cardiac surgery in patients with prosthetic heart valves poses the particular hazards of infective endocarditis, increased bleeding risk and the possibility of acute/subacute valve thrombosis or systemic thromboembolism associated with interrupted anticoagulation. Management is complicated by the absence of randomised trials examining peri-operative anticoagulation management. Thromboembolic risk increases substantially when oral anticoagulation is discontinued and valve thrombosis may be inapparent for 1-2 months. This delayed diagnosis makes it difficult to identify the inciting event, either clinically or in experimental trials. Furthermore, the absence of early post-operative events may falsely suggest that peri-operative anticoagulation was safe and adequate. The approach to management therefore remains controversial. Seamless oral anticoagulation is preferred whenever possible and this is safe for a range of minor procedures, including cardiac catheterisation, dental and ophthalmic surgery. Major surgical procedures require withdrawal of oral anticoagulation before surgery to lower the international normalised ratio (INR) to <1.5 and maintained anticoagulation with unfractionated heparin which should be started when the INR is <2.5 in high risk patients and <2.0 in those at lower risk. The evidence to support the safety of low molecular weight heparins in this situation is scanty and despite its widespread promulgation this approach is NOT recommended. Oral anticoagulation is then resumed post-operatively, though therapeutic levels are not achieved for several days. The determination of which patients require prolonged overlap of heparin and oral anticoagulants is difficult. Clinical judgement is required but these regimes are strongly recommended for those at highest risk of thromboembolism. With strict adherence to these guidelines, the incidence of major complications is low.

• Diagnosis of infective endocarditis.

  Authors: Bernard D Prendergast

  BMJ (Clinical research ed.). 11/2002; 325(7369):845-6.

• Community-associated MRSA (CA-MRSA): an emerging pathogen in infective endocarditis--authors' response

  Authors: B Cherie Millar, Bernard D Prendergast, John E Moore

• Molecular technology in context: a current review of diagnosis and management of infective endocarditis.

  Authors: Faisal F Syed, B Cherie Millar, Bernard D Prendergast

  Progress in cardiovascular diseases. 50(3):181-97.

  Infective endocarditis is an evolving disease that presents as a great a problem to physicians, cardiologists, microbiologists, and cardiac surgeons in both the developed and developing world now asInfective endocarditis is an evolving disease that presents as a great a problem to physicians, cardiologists, microbiologists, and cardiac surgeons in both the developed and developing world now as at any time over the past 3 decades. This article provides the reader with an up-to-date review of epidemiology, etiology, pathogenesis, presentation, diagnosis, and treatment. A major area of ongoing work is an approach to the culture-negative patient resulting in expanding diagnostic techniques. Limitations of current diagnostic strategies are detailed with focus on the use of the polymerase chain reaction to aid diagnosis. The technique offers several advantages, including extreme sensitivity and the opportunity for early diagnosis. Three general circumstances exist in which molecular approaches may be used: (1) identification of agents in cases of culture-negative infective endocarditis; (2) characterization of cultured agent(s) to determine clinical significance; (3) determination of antibiotic resistance. It should be recognized that there are limitations and certain quality assurance measures that should be implemented for optimal use of such methods. However, when executed properly and interpreted in the correct clinical and laboratory context, the incorporation of molecular diagnostics as a major Duke diagnostic criterion has been proposed with widespread support, although it is unlikely to supersede blood cultures as a primary diagnostic tool.