Surgical treatment of active infective endocarditis with paravalvular involvement

Abstract

Surgical treatment of active infective endocarditis with paravalvular involvement Aortic root infection remains a challenging problem in the surgical treatment of both native and prosthetic valve endocarditis. Between 1980 and 1991,73 patients with active aortic valve endocarditis and paravalvular infection underwent operation. Indications for operation included congestive heart failure and uncontrolled sepsis. Aortic root abscesses were located in the noncoronary anulus or in the aorticomitral junction in 45 % of cases, followed by the subannular interventricular septum in 23 % • Two patients had an aorticoatrial fistula, seven an interventricular septal defect. Total or partial left ventricular-aortic dehiscence was observed in 27 patients. All patients underwent aortic valve replacement, nine with simultaneous mitral valve operations. Two of the latter required patch reconstruction of the destroyed aorticomitral septum with double valve replacement. Reconstruction of the aortic base was possible in 16 patients, whereas in 12 total replacement of the aortic root was necessary. In one patient, supracoronary aortic valve replacement was used. Recently, topical application of antibiotics in fibrin sealant was used in 25 patients. The operative mortality rate was 21 % and correlated to preoperative uncontrolled sepsis and the presence of extensive root destruction. Operation for active endocarditis of the aortic root requires radical, individualized techniques and results in an acceptable operative and long-term risk. The use of an antibiotic fibrin compound appears to be a useful prophylactic tool to prevent postoperative residual endocarditis.

Infective endocarditis: surgical therapy

“…The indications for the surgical treatment of infective endocarditis reported in the literature 27,28 are similar to those in our series and may be grouped as follows: severe and progressive heart failure refractory to clinical treatment; infection that could not be controlled with antimicrobial treatment; uncontrolled infection in a cardiac prosthesis, and systemic arterial embolisms. In regard to functional class, as reported by other authors [29][30][31] , most patients were in NYHA functional classes III and IV. Of the indications for surgical treatment, heart failure and infection not controlled with adequate antibiotics are the most common 30,31 .…”

An Alternative Patch Repair Technique During Valve Replacement for Native Valve Endocarditis

“…In circumstances when simple excision of the vegetation is not adequate, reconstruction of the intervalvular fibrous body may be required; the latter further contributes to postoperative morbidity and mortality. Subaortic abscess is associated with NCC in almost half of the patients with this pathology 4 . Debridement and reconstruction of the aorto–mitral continuity during prosthesis implantation enabled secure valve replacement in this challenging situation.…”

Risk Factor Analysis of Hospital Mortality in Patients with Endocarditis with Ring Abscess

“…Watanabe et al 9 concluded that endocarditis caused by Staphylococcus may more often result in paravalvular destruction that endocarditis caused by other bacteria. In our series, Staphylococcus was not the most common organism and was not a predictor of hospital mortality.…”