Modified UFO-Procedure for Severe Endocarditis Using a Folded Double Dacron-Patch - “Die Jenaer Kurze Hose”

Objective: Endocarditis with abscess formation in the intervalvular fibrous body is surgically challenging. Techniques reconstructing the intervalvular fibrous body with bovine pericardial patches have been described (David et al. JTCVS 1997). These patch techniques, however, may quickly become complex. We present a simplified technique using a self-made double Dacron patch (“Jenaer kurze Hose”).

Methods: In cases of aortic valve endocarditis with abscess formation in the intervalvular fibrous body affecting the left atrial roof and the mitral valve, a Dacron tube graft is cut open and folded so that two half shells are overlaying. From this double Dacron patch, a half-circle in the size of a 33 prosthetic valve is excised and the ends are approximated. After cardiac arrest, the aortic valve, the sub-aortic curtain including the roof of the left atrium and the entire anterior leaflet of the mitral valve is resected. The lower half of a mitral valve prosthesis is implanted into the posterior mitral annulus. The premade double patch is then implanted onto the upper half of the implanted mitral prosthesis and sewn to the cardiac base, reconstructing the fibrous trigones. The two patches are split and the lower shell of the patch reconstructs the roof of the left atrium and the upper shell reconstructs the base of the aorta. An aortic valve prosthesis is implanted into the newly reconstructed aortic annulus and the aorta is closed encorperating the remaining patch.

Results: Since 9/2010, 27 patients underwent a UFO procedure. In every case, the decision to operate was deemed ultima ratio for the lack of conservative alternatives. Additional procedures included tricuspid valve repairs, root replacements or CABG. Mean age was 66 and mean EF was 49%. The majority of patients were in NYHA III or IV. The surgical procedure was successful in all patients. Mean X-clamp and bypass times were 170 ± 34 and 250 m ± 56 min. Four patients required an ECLS system in the postoperative course, mainly for relative low output in the face of sepsis-induced vasoplegia. In-hospital mortality was 40%. Quality of life among survivors ranged from “good” to “excellent.”

Conclusion: The use of a preoperatively self-tailored double Dacron patch allows the safe conduct of this complex surgical procedure. The patient population is high risk and mortality is mainly related to the sequelae of the severe endocarditis.