A standardized approach to treat complex aortic valve endocarditis: a case series

Anna Gomes*, Jayant S. Jainandunsing, Sander van Assen, Peter Paul van Geel, Bhanu Sinha, Sandro Gelsomino, Daniel M. Johnson, Ehsan Natour

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

5 Citations (Web of Science)

Abstract

Background: Surgical treatment of complicated aortic valve endocarditis often is challenging, even for experienced surgeons. We aim at demonstrating a standardized surgical approach by stentless bioprostheses for the treatment of aortic valve endocarditis complicated by paravalvular abscess formation. Methods: Sixteen patients presenting with aortic valve endocarditis (4 native and 12 prosthetic valves) and paravalvular abscess formation at various localizations and to different extents were treated by a standardized approach using stentless bioprostheses. The procedure consisted of thorough debridement, root replacement with reimplantation of the coronary arteries and correction of accompanying pathologies (aortoventricular and aortomitral dehiscence, septum derangements, Gerbode defect, total atrioventricular conduction block, mitral and tricuspid valve involvement). Results: All highly complex patients included (14 males and 2 females, median age 63 years [range 31-77]) could be successfully treated with stentless bioprostheses as aortic root replacement. Radical surgical debridement of infected tissue with anatomical recontruction was feasible. Although predicted operative mortality was high (median logarithmic EuroSCORE I of 40.7 [range 12.8-68.3]), in hospital and 30-day mortality rates were favorable (18.8 and 12.5% respectively). Conclusions: Repair of active aortic valve endocarditis complicated by paravalvular abscess formation and destruction of the left ventricular outflow tract with stentless bioprosthesis is a valuable option for both native and prosthetic valves. It presents a standardized approach with a high success rate for complete debridement, is readily available, and yields comparable clinical outcomes to the historical gold standard, repair by homografts. Additionally, use of one type of prosthesis reduces logistical issues and purchasing costs.
Original languageEnglish
Article number32
Number of pages10
JournalJournal of Cardiothoracic Surgery
Volume13
DOIs
Publication statusPublished - 19 Apr 2018

Keywords

  • Infective endocarditis
  • Stentless biopiostheses
  • Abscess
  • High-risk
  • Surgery
  • SINGLE-CENTER EXPERIENCE
  • INFECTIVE ENDOCARDITIS
  • ROOT REPLACEMENT
  • THORACIC-SURGEONS
  • SURGICAL-MANAGEMENT
  • FREESTYLE
  • SOCIETY
  • BIOPROSTHESES
  • GUIDELINES
  • HOMOGRAFT
  • Aortic Valve/microbiology
  • Humans
  • Middle Aged
  • Male
  • Heart Valve Prosthesis/adverse effects
  • Adult
  • Female
  • Retrospective Studies
  • Cardiac Surgical Procedures/methods
  • Bioprosthesis/adverse effects
  • Endocarditis, Bacterial/complications
  • Hospital Mortality
  • Survival Analysis
  • Aged
  • Abscess/etiology

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