Factors Influencing the Results of Double-Valve Surgery in Patients with Fulminant Endocarditis: The Importance of Valve Selection
| Autor: | Roland Hetzer, Michael Hofmann, Miralem Pasic, Onnen Grauhan, Hans B. Lehmkuhl, Henryk Siniawski, Yuguo Weng, Charles A. Yankah |
|---|---|
| Rok vydání: | 2004 |
| Předmět: |
Male
Reoperation Aortic valve medicine.medical_specialty Prosthesis-Related Infections medicine.medical_treatment Risk Assessment Prosthesis Pseudoaneurysm Risk Factors Germany Internal medicine Mitral valve Humans Medicine Endocarditis cardiovascular diseases Heart Valve Prosthesis Implantation Ejection fraction business.industry Incidence Mitral valve replacement Mitral Valve Insufficiency Middle Aged medicine.disease Surgery Survival Rate Treatment Outcome medicine.anatomical_structure Ventricle Heart Valve Prosthesis cardiovascular system Cardiology Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | The Heart Surgery Forum. 7:E405-E410 |
| ISSN: | 1522-6662 1098-3511 |
| DOI: | 10.1532/hsf98.20041075 |
| Popis: | BACKGROUND: Extension of infection below the aortic valve is a serious complication, especially with mitral valve involvement. Mortality is substantial and reinfection can strongly influence outcome. PATIENTS: Of 327 surgical patients with active infective aortic valve endocarditis admitted to the Deutsches Herzzentrum Berlin for surgical treatment between December 1996 and December 2003, 108 had root abscess, and 53 (25.5%) had diagnoses of secondary infective mitral valve disease (SMVD). The mean age (+/-SD) was 53 +/- 14.2 years; there were 37 men and 16 women. METHODS: The secondary lesion on the mitral valve was classified as SMVD requiring double-valve surgery (DVS). This prospective clinical and echocardiographic study revealed 2 paths of infection extension into the mitral valve. In the DVS group, 38 patients (71.7%) had tissue metastatic lesions, and 15 patients (28.3%) had a jet lesion on the mitral valve. Most patients (42) with SMVD had an aortic ring abscess as the primary lesion. RESULTS: All patients with destructive endocarditic doublevalve disease received aortic and mitral valve surgery. In 19 cases (35.8%), mitral valve reconstruction was undertaken; in 4 cases, mitral valve replacement had to be carried out after attempted mitral valve reconstruction. Concomitant mitral valve replacement because of severe damage to the valvular and subvalvular apparatus was performed in 30 patients (56.6%). Other types of surgery performed in 11 cases (20.8%) were 8 closures of a septic ventricular septal defect and 3 closures of a fistula to the right ventricle or right atrium. Twenty-seven patients were treated with a Shelhigh prosthesis, 18 were treated with double-valve replacement (both Shelhigh), and 9 were treated with an aortic Shelhigh prosthesis and concomitant mitral valve reconstruction. Homografts were used in 17 patients, with mitral valve reconstruction carried out in 10 patients and a stented mitral prosthesis in 7. In 9 cases, 2 stented valve prostheses were used. There were 14 early (60 days) deaths (26.4%). Septic shock, severe annular and subannular destruction, and poor left ventricular function (end-diastolic dimension >65 mm, ejection fraction |
| Databáze: | OpenAIRE |
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