Aortic and mitral valve surgery for infective endocarditis with reconstruction of the intervalvular fibrous body: an analysis of clinical outcomes

Abstract

Background: Reconstruction of the aorto-mitral curtain (AMC) for invasive double-valve infective endocarditis (IE) is a rare and challenging procedure. This study presents the short-and mid-term results of reconstruction of AMC in a single center. Methods: From 2016 to 2019, 14 patients with invasive double-valve underwent surgical reconstruction of the AMC, along with either double valve replacement or aortic valve replacement with mitral valve repair.Two patients were diagnosed as Behcet's disease. Bicuspid aortic valve was detected in six patients. Mean follow up was 18.9±12.2 months. Results: Positive blood culture was found in 10 (71.4%) patients: 3 of Abiotrophia defective (21.4%).The mean cardiopulmonary bypass (CPB) time was 154.5±25.9 minutes and the mean cross-clamp time was 116.8±18.2 minutes. One patient died of multiple organ failure (7.1%) 60 days after surgery. There was 1 (7.1%) case of stroke, 1 (7.1%) of atrioventricular block with pacemaker implantation, 1 (7.1%) of reoperation for bleeding. There was no late death during follow-up. The survival at 3 years was 92.9%.Freedom from reoperation at 1, 2, and 3 years was 100%, 100%, and 100% during follow-up, respectively. Conclusions: The double-valve replacement and AMC reconstruction (the Commando procedure) is an effective technique in complex heart valve disease. The short-and mid-term results with this technique are optimal, with a very low in-hospital mortality and nearly 100% of long-term survival during follow-up.

Surgical Aortic Mitral Curtain Replacement: Systematic Review and Metanalysis of Early and Long-Term Results

“…Similarly, the pooled rate of early PM implant was significantly higher ( p = 0.0011) in four studies [ 10 , 11 , 17 , 22 ] where mainly biological prostheses were used versus five studies [ 7 , 12 , 15 , 23 , 24 ] where mainly mechanical prostheses were used; they were, respectively, 34.1% (95% CI 27.4–41.4) vs. 18.2% (95% CI 13.0–24.9) ( Supplemental Figure S3 ).…”

“…All of the selected studies are retrospective, ranging from 7 years [ 10 ] to 29 years [ 11 ]. Five studies take into account the Hemi-Commando procedure [ 10 , 11 , 22 , 23 ] and, together with Davierwala PM et al [ 17 ], they considered only patients with IE as etiology, while the other groups [ 7 , 12 , 15 , 24 ] also considered the other pathological processes ( Supplemental Table S3 ). The main outcomes described by the authors are early (hospitalization up to 30 days) and late mortality (at least 3 years), the rate of reoperation and the rate of recurrence of infective endocarditis ( Table 1 ).…”

“…The highest rate of death was presented by Davierwala et al [ 17 ], and it was 28.3%. The lowest was described by Xuan Jiang et al [ 23 ]. Of note, Davierwala et al [ 17 ] presented older patients (whose mean age was 65.3 ± 12.9) when compared to Xuan Jiang et al [ 23 ] (45.5 ± 13.0).…”

“…The lowest was described by Xuan Jiang et al [ 23 ]. Of note, Davierwala et al [ 17 ] presented older patients (whose mean age was 65.3 ± 12.9) when compared to Xuan Jiang et al [ 23 ] (45.5 ± 13.0). Moreover, the Euroscore II by Davierwala was high (53.0 ± 25.2), but Xuan Jiang et al [ 20 ] did not present data.…”

“…None of the investigated variables significantly impact the pooled proportion of both early deaths and strokes. The pooled proportion of early PM implant in the studies where indication to the surgical procedure was only the presence of endocarditis [ 10 , 11 , 17 , 22 , 23 ] was significantly higher ( p = 0.0099) than in the other studies where extensive calcification and lack of tissues were also followed as indications [ 7 , 12 , 15 , 24 ], and they were, respectively, 32.4% (95% CI 24.7–41.2) vs. 18.8% (95% CI 13.5–25.7) ( Supplemental Figure S2 ).…”