Abdelmotagaly Elgalad1, Amr Arafat2, Tarek Elshazly2, Mohamed Elkahwagy2, Hossam Fawzy2, Ehab Wahby2, Abdel-Hady Taha2, Luiz Sampaio3, Marie-Christine Herregods4, Willy Peetermans5, Paul Herijgers6. 1. Cardiothoracic Surgery Department, Tanta University, Tanta, Gharbeya, Egypt; Cullen Cardiovascular Surgery Research, Texas Heart Institute, Houston, TX, USA. 2. Cardiothoracic Surgery Department, Tanta University, Tanta, Gharbeya, Egypt. 3. Cullen Cardiovascular Surgery Research, Texas Heart Institute, Houston, TX, USA. 4. Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium. 5. Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium. 6. Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium. Electronic address: paul.herijgers@kuleuven.be.
Abstract
BACKGROUND: The optimal aortic substitute in extensive aortic valve active infective endocarditis (AIE) continues to be debated. To determine the surgical approach in aortic valve AIE with infection extension beyond the leaflets, we evaluated the outcome of reconstructive surgery with various valve substitutes in those patients. METHODS: During 2000-2013, 168 patients had surgery for extensive aortic valve AIE. Patients were categorised based on aortic valve substitute: Group A: Stented aortic valve replacement (AVR), Group B: Stented AVR with patch support, Group C: Stentless valve, Group D: Aortic allograft, and Group E: Composite valve graft. Outcome parameters were mortality, postoperative cardiogenic or septic shock, stroke, or reinfection. RESULTS: Stented valves with patch support were more frequently utilised in cases of native valve endocarditis (p<0.001). Postoperative complications were comparable among groups. Concomitant preoperative extension of infection in the mitral valve predicted reinfection (OR 3.6; confidence interval 1.46-8.66; p=0.005). Survival was not affected by operative group (log rank=0.6). Univariable preoperative predictors of mortality were: septic shock (hazard ratio 8.3; 95% confidence interval 3.6-19.2; p<0.001), ejection fraction (hazard ratio 0.96; 95% confidence interval 0.93-0.99; p=0.006), preoperative cardiogenic shock (hazard ratio 1.9; 95%CI 1.1-3.6, p=0.02) and concomitant mitral valve surgery (hazard ratio 1.8; 95% confidence interval 1.2-2.5; p=0.002). CONCLUSIONS: Surgical treatment of extensive aortic valve infective endocarditis remains a challenge. Outcomes were not affected by the surgical complexity of aortic reconstruction procedure or valve substitute. Surgical approach should be tailored to individual patient's characteristics.
BACKGROUND: The optimal aortic substitute in extensive aortic valve active infective endocarditis (AIE) continues to be debated. To determine the surgical approach in aortic valve AIE with infection extension beyond the leaflets, we evaluated the outcome of reconstructive surgery with various valve substitutes in those patients. METHODS: During 2000-2013, 168 patients had surgery for extensive aortic valve AIE. Patients were categorised based on aortic valve substitute: Group A: Stented aortic valve replacement (AVR), Group B: Stented AVR with patch support, Group C: Stentless valve, Group D: Aortic allograft, and Group E: Composite valve graft. Outcome parameters were mortality, postoperative cardiogenic or septic shock, stroke, or reinfection. RESULTS: Stented valves with patch support were more frequently utilised in cases of native valve endocarditis (p<0.001). Postoperative complications were comparable among groups. Concomitant preoperative extension of infection in the mitral valve predicted reinfection (OR 3.6; confidence interval 1.46-8.66; p=0.005). Survival was not affected by operative group (log rank=0.6). Univariable preoperative predictors of mortality were: septic shock (hazard ratio 8.3; 95% confidence interval 3.6-19.2; p<0.001), ejection fraction (hazard ratio 0.96; 95% confidence interval 0.93-0.99; p=0.006), preoperative cardiogenic shock (hazard ratio 1.9; 95%CI 1.1-3.6, p=0.02) and concomitant mitral valve surgery (hazard ratio 1.8; 95% confidence interval 1.2-2.5; p=0.002). CONCLUSIONS: Surgical treatment of extensive aortic valve infective endocarditis remains a challenge. Outcomes were not affected by the surgical complexity of aortic reconstruction procedure or valve substitute. Surgical approach should be tailored to individual patient's characteristics.
Authors: Jeffrey Clemence; Juan Caceres; Tom Ren; Xiaoting Wu; Karen M Kim; Himanshu J Patel; G Michael Deeb; Bo Yang Journal: J Thorac Cardiovasc Surg Date: 2020-08-26 Impact factor: 6.439
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Authors: Marcin P Szczechowicz; Alexander Weymann; Sabreen Mkalaluh; Ahmed Mashhour; Konstantin Zhigalov; Michel Pompeu B O Sá; Alina Zubarevich; Jerry Easo Journal: Braz J Cardiovasc Surg Date: 2021-10-17