Long-term Outcomes of Surgery for Invasive Valvular Endocarditis Involving the Aortomitral Fibrosa
| Autor: | Gösta B. Pettersson, Faisal G. Bakaeen, Ali H. Hakim, James C. Witten, Bruce W. Lytle, Penny L. Houghtaling, Haytham Elgharably, Michael J. Haupt, Lars G. Svensson, Emidio Germano, Jose L. Navia, A. Marc Gillinov, Eric E. Roselli |
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| Rok vydání: | 2019 |
| Předmět: |
Pulmonary and Respiratory Medicine
Male medicine.medical_specialty Time Factors medicine.medical_treatment Fistula Heart Valve Diseases 030204 cardiovascular system & hematology Coronary artery disease 03 medical and health sciences 0302 clinical medicine Aortic valve replacement medicine Endocarditis Humans Abscess Retrospective Studies Heart Valve Prosthesis Implantation Mitral valve repair biology business.industry Endocarditis Bacterial Middle Aged medicine.disease biology.organism_classification Surgery Treatment Outcome 030228 respiratory system Viridans streptococci Infective endocarditis Aortic Valve Mitral Valve Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | The Annals of thoracic surgery. 108(5) |
| ISSN: | 1552-6259 |
| Popis: | Background Reconstruction of the intervalvular fibrosa (IVF) for invasive double-valve infective endocarditis (IE) is a technically challenging operation. This study presents the long-term outcomes of two surgical techniques for IVF reconstruction. Methods From 1988 to 2017, 138 patients with invasive double-valve IE underwent surgical reconstruction of the IVF, along with double-valve replacement (Commando procedure, n = 86) or aortic valve replacement with mitral valve repair (hemi-Commando procedure, n = 52). Mean follow-up was 41 ± 5.9 months. Results Reoperation was required in 82% of patients, and 34% underwent emergency surgery. Pathologic features included positive blood cultures (90%), prosthetic valve IE (75%), aortic root abscess (78%), mitral annular abscess (24%), and intracardiac fistula (12%). There were 28 hospital deaths: 21 (24%) in the Commando group and 7 (14%) in the hemi-Commando group (P = .12). Overall survival at 1, 5, and 10 years was 67%, 48%, and 37%, respectively. Coronary artery disease, native valve IE, and causative organism (Staphylococcus aureus, coagulase-negative Staphylococcus, and viridans streptococci) were risk factors for late mortality. Freedom from reoperation at 1, 5, and 8 years was 87%, 74%, and 55%, respectively. Freedom from recurrent IE at 1, 5, and 8 years was 90%, 78%, and 67%, respectively. Conclusions Although it is technically demanding, surgery for invasive IE involving IVF, which provides the only chance for cure, can be performed with reasonable clinical outcomes. In cases of IE invading the IVF and limited to the anterior mitral valve leaflet, a hemi-Commando procedure that includes mitral valve repair has improved early outcomes. |
| Databáze: | OpenAIRE |
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