Surgery for Active Infective Endocarditis of the Aortic Valve With Infection Extending Beyond the Leaflets
Autor: | Mohamed Shafik Elkahwagy, Willy Peetermans, Marie-Christine Herregods, Abdelmotagaly Elgalad, Hossam Fouad Fawzy, Ehab A. Wahby, Paul Herijgers, Tarek Elshazly, Luiz C. Sampaio, Amr A. Arafat, Abdel-Hady M. Taha |
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Rok vydání: | 2019 |
Předmět: |
Adult
Male Pulmonary and Respiratory Medicine Aortic valve medicine.medical_specialty Reconstructive surgery 030204 cardiovascular system & hematology 03 medical and health sciences Postoperative Complications 0302 clinical medicine Aortic valve replacement medicine.artery medicine Humans 030212 general & internal medicine Stroke Aged Retrospective Studies Aged 80 and over Heart Valve Prosthesis Implantation Native Valve Endocarditis Aorta Endocarditis Septic shock business.industry Middle Aged medicine.disease Surgery medicine.anatomical_structure Aortic Valve Heart Valve Prosthesis Infective endocarditis cardiovascular system Mitral Valve Female Cardiology and Cardiovascular Medicine business |
Zdroj: | Heart, Lung and Circulation. 28:1112-1120 |
ISSN: | 1443-9506 |
Popis: | 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.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.Stented valves with patch support were more frequently utilised in cases of native valve endocarditis (p0.001). 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; p0.001), 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).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. |
Databáze: | OpenAIRE |
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