Download PDF
Thorac Cardiovasc Surg 2023; 71(01): 22-28
DOI: 10.1055/s-0040-1721462
Original Cardiovascular

Long-Term Results of Patch Repair in Destructive Valve Endocarditis

Jing Li
1   Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
,
Christian Zilz
2   Department of Occupational, Social and Environmental Medicine, Ludwig-Maximilian University Hospital Munich, Munich, Germany
,
Bernhard Floerchinger
1   Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
,
Andreas Holzamer
1   Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
,
Daniele Camboni
1   Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
,
Christian Schach
3   Department of Internal Medicine II—Cardiology, University Medical Center Regensburg, Regensburg, Germany
,
Christof Schmid
1   Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
,
Leopold Rupprecht 
1   Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
› Author Affiliations
› Further Information
    Permissions and Reprints All articles of this category

Abstract

Objectives Treatment of destructive endocarditis with abscess formation is a surgical challenge and associated with significant morbidity and mortality. A root replacement is often performed in case of an annular abscess. This retrospective study was designed to assess the long-term outcome of extensive debridement and patch reconstruction as an alternative approach.

Methods Between November 2007 and November 2016, a selected group of 79 patients (29.6% of all surgical endocarditis cases) with native valve endocarditis (NVE, 53.2%) or prosthetic valve endocarditis (PVE, 46.8%) valve endocarditis underwent surgical therapy with extensive annular debridement and patch reconstruction. Their postoperative course, freedom from recurrent endocarditis, and survival at 1, 5, and 7 years were evaluated.

Results About two-thirds of patients were in a stable condition, one-third of patients were in a critical state. The median logistic EuroSCORE I was 17%. Infected tissue was removed, and defect closure was performed, either with autologous pericardium for small defects, or with bovine pericardium for larger defects. Overall, in-hospital mortality was 11.3% (NVE: 9.7%, PVE: 13.2%; p = 0.412). In single valve endocarditis survival at 1, 5, and 7 years was 81, 72, 72%, respectively for NVE, and 80, 57, 57%, respectively for PVE (p = 0.589), whereas in multiple valve endocarditis survival at 1, 5, and 7 years was 82, 82, 82% for NVE, and 61, 61, and 31%, respectively for PVE (p = 0.132). Confirmed late reinfection was very low.

Conclusion Surgical treatment of destructive endocarditis with abscess formation using patch repair techniques offers acceptable early and long-term results. The relapse rate was low. PVE and involvement of multiple valves were associated with worse outcomes.

Keywords

endocarditis - patch repair - survival - recurrence

Author Contribution

J.L. contributed toward conceptualization, data curation, formal analysis, investigation, project administration, methodology, and writing—original draft. C.Z. contributed toward writing—original draft and review and editing. B.F., A.H., D.C., C.S., and C.Sc. contributed toward writing—review and editing. L.R. contributed toward conceptualization, methodology, supervision, writing—original draft, review, and editing.




Publication History

Received: 27 July 2020

Accepted: 02 November 2020

Article published online:
31 December 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Feringa HHH, Shaw LJ, Poldermans D. et al. Mitral valve repair and replacement in endocarditis: a systematic review of literature. Ann Thorac Surg 2007; 83 (02) 564-570
    CrossrefPubMedGoogle Scholar
  • 2 Cotran RS, Kumar V, Robbins SL. Robbins' Pathologic Basis of Disease. 5th ed.. Philadelphia, PA: W.B. Saunders; 1994: 517-582
    Google Scholar
  • 3 Arnett EN, Roberts WC. Valve ring abscess in active infective endocarditis. Frequency, location, and clues to clinical diagnosis from the study of 95 necropsy patients. Circulation 1976; 54 (01) 140-145
    CrossrefPubMedGoogle Scholar
  • 4 John RM, Pugsley W, Treasure T, Sturridge MF, Swanton RH. Aortic root complications of infective endocarditis—influence on surgical outcome. Eur Heart J 1991; 12 (02) 241-248
    CrossrefPubMedGoogle Scholar
  • 5 Fernicola DJ, Roberts WC. Frequency of ring abscess and cuspal infection in active infective endocarditis involving bioprosthetic valves. Am J Cardiol 1993; 72 (03) 314-323
    CrossrefPubMedGoogle Scholar
  • 6 Larbalestier RI, Kinchla NM, Aranki SF, Couper GS, Collins Jr JJ, Cohn LH. Acute bacterial endocarditis. Optimizing surgical results. Circulation 1992; 86 (Suppl. 05) II68-II74
    PubMedGoogle Scholar
  • 7 Dreyfus G, Serraf A, Jebara VA. et al. Valve repair in acute endocarditis. Ann Thorac Surg 1990; 49 (05) 706-711 , discussion 712–713
    CrossrefPubMedGoogle Scholar
  • 8 Durack DT, Lukes AS, Bright DK. Duke Endocarditis Service. New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Am J Med 1994; 96 (03) 200-209
    CrossrefPubMedGoogle Scholar
  • 9 Habib G, Lancellotti P, Antunes MJ. et al. ESC Scientific Document Group. 2015 ESC Guidelines for the management of infective endocarditis: the task force for the management of infective endocarditis of the European Society of Cardiology (ESC). Endorsed by European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J 2015; 36 (44) 3075-3128
    CrossrefPubMedGoogle Scholar
  • 10 Kondov S, Beyersdorf F, Rylski B. et al. Redo aortic root repair in patients with infective prosthetic endocarditis using xenopericardial solutions. Interact Cardiovasc Thorac Surg 2019; 29 (03) 339-343
    CrossrefPubMedGoogle Scholar
  • 11 Wallace SM, Walton BI, Kharbanda RK, Hardy R, Wilson AP, Swanton RH. Mortality from infective endocarditis: clinical predictors of outcome. Heart 2002; 88 (01) 53-60
    CrossrefPubMedGoogle Scholar
  • 12 Jault F, Gandjbakhch I, Rama A. et al. Active native valve endocarditis: determinants of operative death and late mortality. Ann Thorac Surg 1997; 63 (06) 1737-1741
    CrossrefPubMedGoogle Scholar
  • 13 d'Udekem Y, David TE, Feindel CM, Armstrong S, Sun Z. Long-term results of surgery for active infective endocarditis. Eur J Cardiothorac Surg 1997; 11 (01) 46-52
    CrossrefPubMedGoogle Scholar
  • 14 Alexiou C, Langley SM, Stafford H, Lowes JA, Livesey SA, Monro JL. Surgery for active culture-positive endocarditis: determinants of early and late outcome. Ann Thorac Surg 2000; 69 (05) 1448-1454
    CrossrefPubMedGoogle Scholar
  • 15 Delay D, Pellerin M, Carrier M. et al. Immediate and long-term results of valve replacement for native and prosthetic valve endocarditis. Ann Thorac Surg 2000; 70 (04) 1219-1223
    CrossrefPubMedGoogle Scholar
  • 16 Guerra JM, Tornos MP, Permanyer-Miralda G, Almirante B, Murtra M, Soler-Soler J. Long term results of mechanical prostheses for treatment of active infective endocarditis. Heart 2001; 86 (01) 63-68
    PubMedGoogle Scholar
  • 17 David TE, Bos J, Christakis GT, Brofman PR, Wong D, Feindel CM. Heart valve operations in patients with active infective endocarditis. Ann Thorac Surg 1990; 49 (05) 701-705 , discussion 712–713
    CrossrefPubMedGoogle Scholar
  • 18 Delahaye F, Ecochard R, de Gevigney G. et al. The long term prognosis of infective endocarditis. Eur Heart J 1995; 16 (suppl B): 48-53
    CrossrefPubMedGoogle Scholar
  • 19 Tornos MP, Permanyer-Miralda G, Olona M. et al. Long-term complications of native valve infective endocarditis in non-addicts. A 15-year follow-up study. Ann Intern Med 1992; 117 (07) 567-572
    CrossrefPubMedGoogle Scholar
  • 20 Solari S, De Kerchove L, Tamer S. et al. Active infective mitral valve endocarditis: is a repair-oriented surgery safe and durable?. Eur J Cardiothorac Surg 2019; 55 (02) 256-262
    CrossrefPubMedGoogle Scholar
  • 21 David TE, Gavra G, Feindel CM, Regesta T, Armstrong S, Maganti MD. Surgical treatment of active infective endocarditis: a continued challenge. J Thorac Cardiovasc Surg 2007; 133 (01) 144-149
    CrossrefPubMedGoogle Scholar
  • 22 Hill EE, Herijgers P, Herregods M-C, Peetermans WE. Evolving trends in infective endocarditis. Clin Microbiol Infect 2006; 12 (01) 5-12
    CrossrefPubMedGoogle Scholar
  • 23 Revilla A, López J, Vilacosta I. et al. Clinical and prognostic profile of patients with infective endocarditis who need urgent surgery. Eur Heart J 2007; 28 (01) 65-71
    CrossrefPubMedGoogle Scholar
  • 24 Aranki SF, Adams DH, Rizzo RJ. et al. Determinants of early mortality and late survival in mitral valve endocarditis. Circulation 1995; 92 (Suppl. 09) II143-II149
    CrossrefPubMedGoogle Scholar
  • 25 Lalani T, Cabell CH, Benjamin DK. et al. International Collaboration on Endocarditis-Prospective Cohort Study (ICE-PCS) Investigators. Analysis of the impact of early surgery on in-hospital mortality of native valve endocarditis: use of propensity score and instrumental variable methods to adjust for treatment-selection bias. Circulation 2010; 121 (08) 1005-1013
    CrossrefPubMedGoogle Scholar
  • 26 Forteza A, Centeno J, Ospina V. et al. Outcomes in aortic and mitral valve replacement with intervalvular fibrous body reconstruction. Ann Thorac Surg 2015; 99 (03) 838-845
    CrossrefPubMedGoogle Scholar
  • 27 De Oliveira NC, David TE, Armstrong S, Ivanov J. Aortic and mitral valve replacement with reconstruction of the intervalvular fibrous body: an analysis of clinical outcomes. J Thorac Cardiovasc Surg 2005; 129 (02) 286-290
    CrossrefPubMedGoogle Scholar
  • 28 Duran CMG, Gometza B, Shahid M, Al-Halees Z. Treated bovine and autologous pericardium for aortic valve reconstruction. Ann Thorac Surg 1998; 66 (Suppl. 06) S166-S169
    CrossrefPubMedGoogle Scholar
  • 29 Nosál' M, Poruban R, Valentík P, Šagát M, Nagi AS, Kántorová A. Initial experience with polytetrafluoroethylene leaflet extensions for aortic valve repair. Eur J Cardiothorac Surg 2012; 41 (06) 1255-1257 , discussion 1258
    CrossrefPubMedGoogle Scholar
  • 30 El Khoury G, Vohra HA. Polytetrafluoroethylene leaflet extensions for aortic valve repair. Eur J Cardiothorac Surg 2012; 41 (06) 1258-1259
    CrossrefPubMedGoogle Scholar
  • 31 Farivar RS, Shernan SK, Cohn LH. Late rupture of polytetrafluoroethylene neochordae after mitral valve repair. J Thorac Cardiovasc Surg 2009; 137 (02) 504-506
    CrossrefPubMedGoogle Scholar