Subscribe to RSS
Long-Term Results of Patch Repair in Destructive Valve Endocarditis
Objectives Treatment of destructive endocarditis with abscess formation is a surgical challenge and associated with significant morbidity and mortality. A root replacement is often performed in case of an annular abscess. This retrospective study was designed to assess the long-term outcome of extensive debridement and patch reconstruction as an alternative approach.
Methods Between November 2007 and November 2016, a selected group of 79 patients (29.6% of all surgical endocarditis cases) with native valve endocarditis (NVE, 53.2%) or prosthetic valve endocarditis (PVE, 46.8%) valve endocarditis underwent surgical therapy with extensive annular debridement and patch reconstruction. Their postoperative course, freedom from recurrent endocarditis, and survival at 1, 5, and 7 years were evaluated.
Results About two-thirds of patients were in a stable condition, one-third of patients were in a critical state. The median logistic EuroSCORE I was 17%. Infected tissue was removed, and defect closure was performed, either with autologous pericardium for small defects, or with bovine pericardium for larger defects. Overall, in-hospital mortality was 11.3% (NVE: 9.7%, PVE: 13.2%; p = 0.412). In single valve endocarditis survival at 1, 5, and 7 years was 81, 72, 72%, respectively for NVE, and 80, 57, 57%, respectively for PVE (p = 0.589), whereas in multiple valve endocarditis survival at 1, 5, and 7 years was 82, 82, 82% for NVE, and 61, 61, and 31%, respectively for PVE (p = 0.132). Confirmed late reinfection was very low.
Conclusion Surgical treatment of destructive endocarditis with abscess formation using patch repair techniques offers acceptable early and long-term results. The relapse rate was low. PVE and involvement of multiple valves were associated with worse outcomes.
J.L. contributed toward conceptualization, data curation, formal analysis, investigation, project administration, methodology, and writing—original draft. C.Z. contributed toward writing—original draft and review and editing. B.F., A.H., D.C., C.S., and C.Sc. contributed toward writing—review and editing. L.R. contributed toward conceptualization, methodology, supervision, writing—original draft, review, and editing.
Received: 27 July 2020
Accepted: 02 November 2020
31 December 2020 (online)
© 2020. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
- 1 Feringa HHH, Shaw LJ, Poldermans D. et al. Mitral valve repair and replacement in endocarditis: a systematic review of literature. Ann Thorac Surg 2007; 83 (02) 564-570
- 2 Cotran RS, Kumar V, Robbins SL. Robbins' Pathologic Basis of Disease. 5th ed.. Philadelphia, PA: W.B. Saunders; 1994: 517-582
- 3 Arnett EN, Roberts WC. Valve ring abscess in active infective endocarditis. Frequency, location, and clues to clinical diagnosis from the study of 95 necropsy patients. Circulation 1976; 54 (01) 140-145
- 4 John RM, Pugsley W, Treasure T, Sturridge MF, Swanton RH. Aortic root complications of infective endocarditis—influence on surgical outcome. Eur Heart J 1991; 12 (02) 241-248
- 5 Fernicola DJ, Roberts WC. Frequency of ring abscess and cuspal infection in active infective endocarditis involving bioprosthetic valves. Am J Cardiol 1993; 72 (03) 314-323
- 6 Larbalestier RI, Kinchla NM, Aranki SF, Couper GS, Collins Jr JJ, Cohn LH. Acute bacterial endocarditis. Optimizing surgical results. Circulation 1992; 86 (Suppl. 05) II68-II74
- 7 Dreyfus G, Serraf A, Jebara VA. et al. Valve repair in acute endocarditis. Ann Thorac Surg 1990; 49 (05) 706-711 , discussion 712–713
- 8 Durack DT, Lukes AS, Bright DK. Duke Endocarditis Service. New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Am J Med 1994; 96 (03) 200-209
- 9 Habib G, Lancellotti P, Antunes MJ. et al. ESC Scientific Document Group. 2015 ESC Guidelines for the management of infective endocarditis: the task force for the management of infective endocarditis of the European Society of Cardiology (ESC). Endorsed by European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J 2015; 36 (44) 3075-3128
- 10 Kondov S, Beyersdorf F, Rylski B. et al. Redo aortic root repair in patients with infective prosthetic endocarditis using xenopericardial solutions. Interact Cardiovasc Thorac Surg 2019; 29 (03) 339-343
- 11 Wallace SM, Walton BI, Kharbanda RK, Hardy R, Wilson AP, Swanton RH. Mortality from infective endocarditis: clinical predictors of outcome. Heart 2002; 88 (01) 53-60
- 12 Jault F, Gandjbakhch I, Rama A. et al. Active native valve endocarditis: determinants of operative death and late mortality. Ann Thorac Surg 1997; 63 (06) 1737-1741
- 13 d'Udekem Y, David TE, Feindel CM, Armstrong S, Sun Z. Long-term results of surgery for active infective endocarditis. Eur J Cardiothorac Surg 1997; 11 (01) 46-52
- 14 Alexiou C, Langley SM, Stafford H, Lowes JA, Livesey SA, Monro JL. Surgery for active culture-positive endocarditis: determinants of early and late outcome. Ann Thorac Surg 2000; 69 (05) 1448-1454
- 15 Delay D, Pellerin M, Carrier M. et al. Immediate and long-term results of valve replacement for native and prosthetic valve endocarditis. Ann Thorac Surg 2000; 70 (04) 1219-1223
- 16 Guerra JM, Tornos MP, Permanyer-Miralda G, Almirante B, Murtra M, Soler-Soler J. Long term results of mechanical prostheses for treatment of active infective endocarditis. Heart 2001; 86 (01) 63-68
- 17 David TE, Bos J, Christakis GT, Brofman PR, Wong D, Feindel CM. Heart valve operations in patients with active infective endocarditis. Ann Thorac Surg 1990; 49 (05) 701-705 , discussion 712–713
- 18 Delahaye F, Ecochard R, de Gevigney G. et al. The long term prognosis of infective endocarditis. Eur Heart J 1995; 16 (suppl B): 48-53
- 19 Tornos MP, Permanyer-Miralda G, Olona M. et al. Long-term complications of native valve infective endocarditis in non-addicts. A 15-year follow-up study. Ann Intern Med 1992; 117 (07) 567-572
- 20 Solari S, De Kerchove L, Tamer S. et al. Active infective mitral valve endocarditis: is a repair-oriented surgery safe and durable?. Eur J Cardiothorac Surg 2019; 55 (02) 256-262
- 21 David TE, Gavra G, Feindel CM, Regesta T, Armstrong S, Maganti MD. Surgical treatment of active infective endocarditis: a continued challenge. J Thorac Cardiovasc Surg 2007; 133 (01) 144-149
- 22 Hill EE, Herijgers P, Herregods M-C, Peetermans WE. Evolving trends in infective endocarditis. Clin Microbiol Infect 2006; 12 (01) 5-12
- 23 Revilla A, López J, Vilacosta I. et al. Clinical and prognostic profile of patients with infective endocarditis who need urgent surgery. Eur Heart J 2007; 28 (01) 65-71
- 24 Aranki SF, Adams DH, Rizzo RJ. et al. Determinants of early mortality and late survival in mitral valve endocarditis. Circulation 1995; 92 (Suppl. 09) II143-II149
- 25 Lalani T, Cabell CH, Benjamin DK. et al. International Collaboration on Endocarditis-Prospective Cohort Study (ICE-PCS) Investigators. Analysis of the impact of early surgery on in-hospital mortality of native valve endocarditis: use of propensity score and instrumental variable methods to adjust for treatment-selection bias. Circulation 2010; 121 (08) 1005-1013
- 26 Forteza A, Centeno J, Ospina V. et al. Outcomes in aortic and mitral valve replacement with intervalvular fibrous body reconstruction. Ann Thorac Surg 2015; 99 (03) 838-845
- 27 De Oliveira NC, David TE, Armstrong S, Ivanov J. Aortic and mitral valve replacement with reconstruction of the intervalvular fibrous body: an analysis of clinical outcomes. J Thorac Cardiovasc Surg 2005; 129 (02) 286-290
- 28 Duran CMG, Gometza B, Shahid M, Al-Halees Z. Treated bovine and autologous pericardium for aortic valve reconstruction. Ann Thorac Surg 1998; 66 (Suppl. 06) S166-S169
- 29 Nosál' M, Poruban R, Valentík P, Šagát M, Nagi AS, Kántorová A. Initial experience with polytetrafluoroethylene leaflet extensions for aortic valve repair. Eur J Cardiothorac Surg 2012; 41 (06) 1255-1257 , discussion 1258
- 30 El Khoury G, Vohra HA. Polytetrafluoroethylene leaflet extensions for aortic valve repair. Eur J Cardiothorac Surg 2012; 41 (06) 1258-1259
- 31 Farivar RS, Shernan SK, Cohn LH. Late rupture of polytetrafluoroethylene neochordae after mitral valve repair. J Thorac Cardiovasc Surg 2009; 137 (02) 504-506