Aortic root abscess and secondary infective mitral valve disease: results of surgical endocarditis treatment

Siniawski, Henryk; Grauhan, O.; Hofmann, Michael; Pašić, Miralem; Weng, Yuguo; Yankah, Charles; Lehmkuhl, H.; Hetzer, Roland

doi:10.1016/j.ejcts.2004.12.001

Cited by 33 publications

(16 citation statements)

References 18 publications

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“…5 A large prospective study carried out by several clinics showed that staphylococci were responsible for IE in major risk groups like intravenous-drug users and patients with intracardiac devices in place. 14 We were able to document only 18 of 27 patients as culture positive, and 8 of those died. Nine culture-negative patients were diagnosed in other hospitals, and their antibiotherapies were already started; they were sent to our department for aortic root surgery because of the sequelae of IE.…”

Section: Discussionmentioning

confidence: 99%

Surgery for Aortic Root Abscess: A 15-Year Experience

Kırali¹,

Sarikaya²,

Özen³

et al. 2016

Texas Heart Institute Journal

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Aortic root abscess is the most severe sequela of infective endocarditis, and its surgical management is a complicated procedure because of the high risk of morbidity and death. Twenty-seven patients were included in this 15-year retrospective study: 21 (77.8%) with native- and 6 (22.2%) with prosthetic-valve endocarditis. The surgical reconstruction of the aortic root consisted of aortic valve replacement in 19 patients (70.4%) with (11) or without (8) a pericardial patch, or total aortic root replacement in 7 patients (25.9%); 5 of the 27 (18.5%) underwent the modified Bentall procedure with the flanged conduit. Only one patient (3.7%) underwent subaortic pericardial patch reconstruction without valve replacement. A total of 7 patients (25.9%) underwent reoperation: 6 with prior valve surgery, and 1 with prior isolated sinus of Valsalva repair. The mean follow-up period was 6.8 ± 3.7 years. There were 6 (22.2%) in-hospital deaths, 3 (11.1%) of which were perioperative, among patients who underwent emergent surgery. Five patients (23.8%) died during follow-up, and the overall survival rates at 1, 5, and 10 years were 70.3% ± 5.8%, 62.9% ± 6.4%, and 59.2% ± 7.2%, respectively. Two of 21 patients (9.5%) underwent reoperation because of paravalvular leakage and early recurrence of infection during follow-up. After complete resection of the perianular abscess, replacement of the aortic root can be implemented for reconstruction of the aortic root, with or without left ventricular outflow tract injuries. Replacing the aortic root with a flanged composite graft might provide the best anatomic fit.

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Section: Discussionmentioning

confidence: 99%

Surgery for Aortic Root Abscess: A 15-Year Experience

Kırali¹,

Sarikaya²,

Özen³

et al. 2016

Texas Heart Institute Journal

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“…In-hospital mortality depends on the proportion of active versus healed endocarditis in the patient population and on the inclusion of prosthetic endocarditis. The highest mortality was observed in a series of patients with aortic abscess and mitral endocarditis [50]. Abscess and severe aortic root destruction is a well-recognized factor of poor prognosis after multivalve surgery for endocarditis, along with prosthetic endocarditis, severe heart failure, renal failure, shock, emergency surgery, age, and diabetes mellitus [10•, 11, 12, 13•, 14•, [15,50].…”

Section: Prognosis Of Multivalvular Iementioning

confidence: 99%

Clinical and Microbiologic Features of Multivalvular Endocarditis

Selton-Suty

Doco‐Lecompte

Bernard

et al. 2010

Curr Infect Dis Rep

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Multivalvular endocarditis accounts for 15% of all endocarditis. The mechanisms of spread of the infection differs whether endocarditis is only left-sided (involving both the mitral and aortic valves) or bilateral. In left-sided bivalvular endocarditis, it is often a secondary mitral lesion following a primary aortic endocarditis. Multivalvular endocarditis often results in severe and extensive cardiac lesions, well described at echocardiography and frequently responsible for severe heart failure. Patients often need surgery, which consists of radical debridement of all the infected tissue with reconstruction using different types of prostheses; therefore, the surgery may be very complex. The goal should be an early diagnosis of endocarditis to avoid spread of the infection to more than one valve, to improve the prognosis for those patients.

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“…Stentless prostheses seem to offer low reinfection rates, ranging from 3.7% to 8.6% [ 7 , 28 ]. The low reinfection rates and good hemodynamic values are comparable to those of cryopreserved homografts.…”

Section: Discussionmentioning

confidence: 99%

Valve selection in aortic valve endocarditis

Perrotta

Zubrytska

2016

kitp

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Aortic prosthetic valve endocarditis (PVE) is a potentially life-threatening disease. Mortality and incidence of infective endocarditis have been reduced in the past 30 years. Medical treatment of aortic PVE may be successful in patients who have a prompt response after antibiotic treatment and who do not have prosthetic dysfunction. In advanced stages, antibiotic therapy alone is insufficient to control the disease, and surgical intervention is necessary. Surgical treatment may be lifesaving, but it is still associated with considerable morbidity and mortality. The aim of surgery is to perform a radical excision of all infected and necrotic tissue, reconstruction of the left ventricle outflow tract, and replacement of the aortic valve. There is no unanimous consensus on which is the optimal prosthesis to implant in this context, and several surgical techniques have been suggested. We aim to analyze the efficacy of the surgical treatment and discuss the issue of valve selection in patients with aortic valve endocarditis.

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Aortic root abscess and secondary infective mitral valve disease: results of surgical endocarditis treatment

Cited by 33 publications

References 18 publications

Surgery for Aortic Root Abscess: A 15-Year Experience

Surgery for Aortic Root Abscess: A 15-Year Experience

Clinical and Microbiologic Features of Multivalvular Endocarditis

Valve selection in aortic valve endocarditis

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