Double valve replacement and reconstruction of the intervalvular fibrous body in patients with active infective endocarditis

Piroze M. Davierwala, Christian Binner, Sreekumar - Subramanian, Maximilian Luehr, Bettina Pfannmueller, Christian Etz, Pascal Dohmen, Martin Misfeld, Michael A. Borger, Friedrich W. Mohr

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

OBJECTIVES: Destruction of the intervalvular fibrous body, though uncommon, occurs due to paravalvular abscess formation following active infective endocarditis. This warrants a highly complex operation involving radical surgical debridement of the intervalvular fibrous body, followed by double valve (aortic and mitral) replacement with patch reconstruction of the anterior mitral annulus, the left ventricular outflow tract and the left atrial roof. The objective of this study was to review the early and mid-term outcomes in patients undergoing this operation. METHODS: A total of 25 patients underwent double valve replacement with reconstruction of the intervalvular fibrous body for extensive infective endocarditis between January 1999 and March 2012. The mean age was 64.3 ± 10.5 years. Most of the patients (60%) were in New York Heart Association Class III-IV, 12% and in cardiogenic shock. Associated comorbidities like acute renal insufficiency and cerebrovascular accidents were observed in 40 and 20% of patients, respectively. Twenty patients had previous heart valve surgeries. The logistic EuroSCORE predicted risk of mortality was 55.1 ± 22.9%. RESULTS: Overall, 30-day mortality was 32%. Postoperative complications like low cardiac output, stroke and acute renal failure developed in 16, 28 and 56%, respectively. Thirty-two percent of patients required re-exploration for bleeding. Nine patients were alive at a mean follow-up of 406 days (0-8 years). The 2- and 5-year survivals were 37.0 ± 11.1 and 24.6 ± 12.5%, respectively. CONCLUSIONS: Double valve replacement with reconstruction of the intervalvular fibrous body for infective endocarditis is a complex, technically challenging operation associated with high perioperative morbidity and mortality. Nevertheless, being the only option available for such complex disease, it should be performed in these patients who, otherwise, face 100% mortality.

Original languageEnglish (US)
Article numberezt226
Pages (from-to)146-152
Number of pages7
JournalEuropean Journal of Cardio-thoracic Surgery
Volume45
Issue number1
DOIs
StatePublished - Jan 2014

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Endocarditis
Mortality
Acute Kidney Injury
Stroke
Low Cardiac Output
Cardiogenic Shock
Heart Valves
Debridement
Aortic Valve
Mitral Valve
Abscess
Thoracic Surgery
Comorbidity
Hemorrhage
Morbidity
Survival

Keywords

  • Aortic valve replacement
  • Endocarditis
  • Mitral valve replacement

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Double valve replacement and reconstruction of the intervalvular fibrous body in patients with active infective endocarditis. / Davierwala, Piroze M.; Binner, Christian; Subramanian, Sreekumar -; Luehr, Maximilian; Pfannmueller, Bettina; Etz, Christian; Dohmen, Pascal; Misfeld, Martin; Borger, Michael A.; Mohr, Friedrich W.

In: European Journal of Cardio-thoracic Surgery, Vol. 45, No. 1, ezt226, 01.2014, p. 146-152.

Research output: Contribution to journalArticle

Davierwala, PM, Binner, C, Subramanian, S, Luehr, M, Pfannmueller, B, Etz, C, Dohmen, P, Misfeld, M, Borger, MA & Mohr, FW 2014, 'Double valve replacement and reconstruction of the intervalvular fibrous body in patients with active infective endocarditis', European Journal of Cardio-thoracic Surgery, vol. 45, no. 1, ezt226, pp. 146-152. https://doi.org/10.1093/ejcts/ezt226
Davierwala, Piroze M. ; Binner, Christian ; Subramanian, Sreekumar - ; Luehr, Maximilian ; Pfannmueller, Bettina ; Etz, Christian ; Dohmen, Pascal ; Misfeld, Martin ; Borger, Michael A. ; Mohr, Friedrich W. / Double valve replacement and reconstruction of the intervalvular fibrous body in patients with active infective endocarditis. In: European Journal of Cardio-thoracic Surgery. 2014 ; Vol. 45, No. 1. pp. 146-152.
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abstract = "OBJECTIVES: Destruction of the intervalvular fibrous body, though uncommon, occurs due to paravalvular abscess formation following active infective endocarditis. This warrants a highly complex operation involving radical surgical debridement of the intervalvular fibrous body, followed by double valve (aortic and mitral) replacement with patch reconstruction of the anterior mitral annulus, the left ventricular outflow tract and the left atrial roof. The objective of this study was to review the early and mid-term outcomes in patients undergoing this operation. METHODS: A total of 25 patients underwent double valve replacement with reconstruction of the intervalvular fibrous body for extensive infective endocarditis between January 1999 and March 2012. The mean age was 64.3 ± 10.5 years. Most of the patients (60{\%}) were in New York Heart Association Class III-IV, 12{\%} and in cardiogenic shock. Associated comorbidities like acute renal insufficiency and cerebrovascular accidents were observed in 40 and 20{\%} of patients, respectively. Twenty patients had previous heart valve surgeries. The logistic EuroSCORE predicted risk of mortality was 55.1 ± 22.9{\%}. RESULTS: Overall, 30-day mortality was 32{\%}. Postoperative complications like low cardiac output, stroke and acute renal failure developed in 16, 28 and 56{\%}, respectively. Thirty-two percent of patients required re-exploration for bleeding. Nine patients were alive at a mean follow-up of 406 days (0-8 years). The 2- and 5-year survivals were 37.0 ± 11.1 and 24.6 ± 12.5{\%}, respectively. CONCLUSIONS: Double valve replacement with reconstruction of the intervalvular fibrous body for infective endocarditis is a complex, technically challenging operation associated with high perioperative morbidity and mortality. Nevertheless, being the only option available for such complex disease, it should be performed in these patients who, otherwise, face 100{\%} mortality.",
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AU - Davierwala, Piroze M.

AU - Binner, Christian

AU - Subramanian, Sreekumar -

AU - Luehr, Maximilian

AU - Pfannmueller, Bettina

AU - Etz, Christian

AU - Dohmen, Pascal

AU - Misfeld, Martin

AU - Borger, Michael A.

AU - Mohr, Friedrich W.

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N2 - OBJECTIVES: Destruction of the intervalvular fibrous body, though uncommon, occurs due to paravalvular abscess formation following active infective endocarditis. This warrants a highly complex operation involving radical surgical debridement of the intervalvular fibrous body, followed by double valve (aortic and mitral) replacement with patch reconstruction of the anterior mitral annulus, the left ventricular outflow tract and the left atrial roof. The objective of this study was to review the early and mid-term outcomes in patients undergoing this operation. METHODS: A total of 25 patients underwent double valve replacement with reconstruction of the intervalvular fibrous body for extensive infective endocarditis between January 1999 and March 2012. The mean age was 64.3 ± 10.5 years. Most of the patients (60%) were in New York Heart Association Class III-IV, 12% and in cardiogenic shock. Associated comorbidities like acute renal insufficiency and cerebrovascular accidents were observed in 40 and 20% of patients, respectively. Twenty patients had previous heart valve surgeries. The logistic EuroSCORE predicted risk of mortality was 55.1 ± 22.9%. RESULTS: Overall, 30-day mortality was 32%. Postoperative complications like low cardiac output, stroke and acute renal failure developed in 16, 28 and 56%, respectively. Thirty-two percent of patients required re-exploration for bleeding. Nine patients were alive at a mean follow-up of 406 days (0-8 years). The 2- and 5-year survivals were 37.0 ± 11.1 and 24.6 ± 12.5%, respectively. CONCLUSIONS: Double valve replacement with reconstruction of the intervalvular fibrous body for infective endocarditis is a complex, technically challenging operation associated with high perioperative morbidity and mortality. Nevertheless, being the only option available for such complex disease, it should be performed in these patients who, otherwise, face 100% mortality.

AB - OBJECTIVES: Destruction of the intervalvular fibrous body, though uncommon, occurs due to paravalvular abscess formation following active infective endocarditis. This warrants a highly complex operation involving radical surgical debridement of the intervalvular fibrous body, followed by double valve (aortic and mitral) replacement with patch reconstruction of the anterior mitral annulus, the left ventricular outflow tract and the left atrial roof. The objective of this study was to review the early and mid-term outcomes in patients undergoing this operation. METHODS: A total of 25 patients underwent double valve replacement with reconstruction of the intervalvular fibrous body for extensive infective endocarditis between January 1999 and March 2012. The mean age was 64.3 ± 10.5 years. Most of the patients (60%) were in New York Heart Association Class III-IV, 12% and in cardiogenic shock. Associated comorbidities like acute renal insufficiency and cerebrovascular accidents were observed in 40 and 20% of patients, respectively. Twenty patients had previous heart valve surgeries. The logistic EuroSCORE predicted risk of mortality was 55.1 ± 22.9%. RESULTS: Overall, 30-day mortality was 32%. Postoperative complications like low cardiac output, stroke and acute renal failure developed in 16, 28 and 56%, respectively. Thirty-two percent of patients required re-exploration for bleeding. Nine patients were alive at a mean follow-up of 406 days (0-8 years). The 2- and 5-year survivals were 37.0 ± 11.1 and 24.6 ± 12.5%, respectively. CONCLUSIONS: Double valve replacement with reconstruction of the intervalvular fibrous body for infective endocarditis is a complex, technically challenging operation associated with high perioperative morbidity and mortality. Nevertheless, being the only option available for such complex disease, it should be performed in these patients who, otherwise, face 100% mortality.

KW - Aortic valve replacement

KW - Endocarditis

KW - Mitral valve replacement

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