Thorac Cardiovasc Surg 2012; 60 - V225
DOI: 10.1055/s-0031-1297615

The unidentified flying object (UFO) operation. Double valve replacement and intervalvular fibrous body reconstruction

M Misfeld 1, S Subramanian 1, P Davierwala 1, S Leontyev 1, MA Borger 1, C Binner 1, FW Mohr 1
  • 1Herzzentrum, Universität Leipzig, Klinik für Herzchirurgie, Leipzig, Germany

Objectives: Destruction of the intervalvular fibrous body (IFB) is an uncommon sequela of infective endocarditis (IE). In these cases, radical surgical debridement, followed by double valve (aortic and mitral) replacement and patch reconstruction of the left ventricular outflow tract (LVOT) and the atrial roof is required. We refer to this operation as an unidentified flying object (UFO) because of its anatomic complexity with mitral valve replacement through the aortic root. The objective of this study was to review our experience with the "UFO" operation.

Methods: Retrospective review of the Heart Center database identified 21 patients between 1999 and 2011 who underwent an "UFO" for extensive infective endocarditis involving the aortic and mitral valves, as well as the IFB.

Results: Mean age was 62±12y (86% men). Mitral valve replacement was mechanical in 4/21 (19%), biological in 17/21 (81%), while the aortic pathology was most commonly treated with a freestyle (8/21, 38%) or a homograft (4/21, 19%) root replacement. Operative, cardiopulmonary bypass and cross-clamp times were 411±121min, 283+/-81min, and 174±45min, respectively. Morbidity included reoperation for bleeding in 33%, low cardiac output 44%, stroke in 11%, and renal failure in 55% Hospital mortality was 9/21 (42.9%). At a mean follow-up of 406 days (range 0–8 years), 6/12 patients were alive.

Conclusions: The "UFO" operation is technically challenging, associated with long operative times and significant peri-operative morbidity and mortality. Nevertheless, since the operation is often a last resort for patients, the technique should continue to be performed in selected cases.