Thorac Cardiovasc Surg 2019; 67(08): 624-630
DOI: 10.1055/s-0038-1673634
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Evaluation of Strategies in the Management of Infective Aortic Valve Endocarditis at German Cardiac Surgical Departments

1  Department of Cardiovascular Surgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
Hug Aubin
1  Department of Cardiovascular Surgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
Maximilian Lühr
2  Department of Cardiac Surgery, University Hospital, LMU Munich, Germany
Ardawan Julian Rastan
3  Department of Cardiac and Vascular Surgery, Herz-Kreislauf-Zentrum Rotenburg, Rotenburg a.d. Fulda, Germany
Andreas Beckmann
4  Deutsche Gesellschaft für Thorax-, Herz- und Gefäßchirurgie – [DGTHG], Berlin, Germany
Martin Misfeld
5  Department of Cardiac Surgery, Heart Centre, University of Leipzig, Leipzig, Germany
on behalf of the Working Group Aortic Valve Surgery and the Board of Directors of the German Society for Thoracic Cardiovascular Surgery› Author Affiliations
Funding The costs associated with design and distribution of the questionnaire as well as subsequent collection and analysis of the answers were covered by DGTHG and the institutional funds of the institutions of the authors of this work.
Further Information

Publication History

10 January 2018

23 August 2018

Publication Date:
28 November 2018 (online)


Background Surgical treatment of infective aortic valve endocarditis (AVE) remains a therapeutic challenge, necessitating interdisciplinary approach to limit morbidity and mortality in this high-risk cohort. With a considerable spectrum of available laboratory testings, imaging techniques, as well as operative strategies developed in recent years, there is a lack of standardization across cardiac surgical departments in Germany. Thus, the optimal treatment strategy of AVE has yet to be defined.

Methods A nationwide survey on infective AVE was conducted, including 64 cardiac surgical departments responding to a 41-item questionnaire. The evaluation included common surgical practice, routine diagnostic steps, surgical techniques, perioperative medical treatment, as well as postoperative management.

Results Remarkable differences were observed among the participating institutions, including the following components of the treatment: (1) standardization and extent of the use of imaging techniques and (2) success rate in identification AVE-causing germs, (3) timing of operation in case of cerebral embolization, and (4) choice of valve prosthesis for aortic valve replacement for infective AVE.

Conclusion The findings of this survey underline the need for a nationwide registry to further elucidate the nature and course of AVE in Germany, as well as to serve as a solid basis for prospective trials, addressing the most important clinical purposes in the diagnosis and treatment of AVE.


This paper was presented at the 45th annual meeting of the German Society for Thoracic and Cardiovascular Surgery, Leipzig, February 2016.

Supplementary Material