Endoscopic port access surgery for isolated atrioventricular valve endocarditis†

Abstract

Complex atrioventricular valve surgery in the context of AVVE can be endoscopically performed in experienced centres and should not deter surgeons from offering patients with AVVE the potential benefits of minimally invasive cardiac surgery.

Systematic Review of Minimally Invasive Surgery for Mitral Valve Infective Endocarditis

“…Of note, one of the included studies included 6 patients (out of 66 total) with isolated tricuspid valve endocarditis. 10 The average in-hospital mortality was 9.4%, with average length of hospital stay of 21.6 days. Survival was 89.1% at 30 days and 79.3% at or above 1 year.…”

“…We identified 6 reports (5 case series without comparison groups and 1 cohort study comparing against median sternotomy) involving a total of 271 patients. 9 -14 The patients had mean age 60.4 ± 14.9 years and 60.1% were male. Mean EuroSCORE II was 24.6 ± 23.2 in studies that reported values.…”

Minimally invasive atrioventricular valve surgery – current status and future perspectives

“…The incidence of MIAS conversion to CSA due to adverse intraoperative events ranges considerably, with experienced centres reporting an incidence of 3.0% (64) -3.7%. (17) The group from Aalst suggested an increased mortality associated with conversion during PAS (64) and also reported their individual conversion rates in the context of complex isolated AVV endocarditis (9.1%), (74) redo-PAS after previous PAS (19.2%), (75) difficult access congenital chest wall deformities (0%), (76) extreme obesity (0%), (77) post-cardiac transplantation (0%) (78) and hypertrophic obstructive cardiomyopathy with associated AVV disease (0%).…”

“…(89)(90)(91)(92) However, in-hospital stabilisation of anti-coagulation regimes and completion of a 6-week antibiotic course in cases of infective endocarditis, does not reflect the isolated impact on hospitalisation of MIAS. (74)(75)(76)(77)(78) In-hospital mortality Contemporary reports do not suggest a significant all-cause inhospital mortality difference between MIAS and CSA (52)(53)(54)(55)(56)(57)(58)(59)(60)(61)(62)(63) or EBAO and DAC. (70)(71)(72)(73) The group from Aalst reported a perioperative mortality of 2.6% for their PAS series.…”

“…Limited comparative reports on long term risk of all-cause mortality between MIAS and CSA are available and do not identify a significant 1-and 3-year survival difference. (45) The group from Aalst reported the intermediate-and long-term PAS survival in the context of infective endocarditis (mean 63.2 ± 42.5 months, 69.4% at 10 years), (74) extreme obesity (mean 39.4 ± 88.4 months, 100%), (76) left ventricle outflow tract resection and AVV surgery (mean 49.7 ± 30.0, 100%) and redo-PAS after previous PAS (mean 48.3 ± 39.2, 95.8% at 5 years). (75)…”