Repair for active infective atrioventricular valve endocarditis: 23-year single center experience View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2011-06-25

AUTHORS

Michele Musci, Michael Hübler, Aref Amiri, Julia Stein, Susanne Kosky, Yuguo Weng, Miralem Pasic, Roland Hetzer

ABSTRACT

ObjectivesWe retrospectively compared early and long-term results of mitral (MV) and tricuspid valve (TV) repair in patients with isolated active infective atrioventricular valve (AV) endocarditis over a period of 23 years.MethodsBetween April 1986 and December 2009, a total of 1,409 patients with active infective endocarditis (AIE) were operated upon. Of these, 106 (7.2%) patients (n = 69 men, age 2–84 years) underwent repair of AVE (MV n = 68, TV n = 38). Repair techniques included vegetectomy and leaflet resection, annular plication and annuloplasty, and pericardial patch leaflet and annular reconstruction without any artificial device. Perioperative characteristics, probability of survival, freedom from recurrence and reoperation, and predictors for early mortality were analyzed. Follow-up (0–23 years) was completed in 95% with a total of 667 patient years.ResultsThe 30-day, 1-, 5- and 10-year survival rate for MV repair was 89.7 ± 0.4, 82.2 ± 4.6, 72.6 ± 5.5 and 56.5 ± 7.3% and for TV repair 94.7 ± 3.7, 88.7 ± 5.3, 69.4 ± 8.8 and 64.5 ± 9.5%, respectively (ns).Three patients (2.8%) had to undergo reoperation due to early failure of reconstruction (n = 2 MV, n = 1 TV). Freedom from valve-related reoperation at 1 and 10 years was 88.4 ± 4.1 and 75.4 ± 7.4% for the MV repair and 97.4 ± 2.6 and 93.94 ± 4.2% for the TV repair group (ns).Endocarditis reoccurred early in 2 MV repair patients (1.9%). Freedom from reoperation due to reinfection at 1 and 10 years after MV repair was 96.6 ± 2.3 and 91.6 ± 5.4% and after TV repair 100 and 83.3 ± 9.5%.ConclusionsRepair for AV endocarditis yields excellent results. It is associated with low operative mortality and provides satisfactory early and long-term survival and favorable freedom from recurrent endocarditis and repeat operation. It should be considered as the primary surgical option in these patients, and AV replacement should be performed only in cases of severe AV destruction that renders repair techniques impossible. More... »

PAGES

993-1002

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00392-011-0331-2

DOI

http://dx.doi.org/10.1007/s00392-011-0331-2

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1040565333

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/21706199


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36 schema:description ObjectivesWe retrospectively compared early and long-term results of mitral (MV) and tricuspid valve (TV) repair in patients with isolated active infective atrioventricular valve (AV) endocarditis over a period of 23 years.MethodsBetween April 1986 and December 2009, a total of 1,409 patients with active infective endocarditis (AIE) were operated upon. Of these, 106 (7.2%) patients (n = 69 men, age 2–84 years) underwent repair of AVE (MV n = 68, TV n = 38). Repair techniques included vegetectomy and leaflet resection, annular plication and annuloplasty, and pericardial patch leaflet and annular reconstruction without any artificial device. Perioperative characteristics, probability of survival, freedom from recurrence and reoperation, and predictors for early mortality were analyzed. Follow-up (0–23 years) was completed in 95% with a total of 667 patient years.ResultsThe 30-day, 1-, 5- and 10-year survival rate for MV repair was 89.7 ± 0.4, 82.2 ± 4.6, 72.6 ± 5.5 and 56.5 ± 7.3% and for TV repair 94.7 ± 3.7, 88.7 ± 5.3, 69.4 ± 8.8 and 64.5 ± 9.5%, respectively (ns).Three patients (2.8%) had to undergo reoperation due to early failure of reconstruction (n = 2 MV, n = 1 TV). Freedom from valve-related reoperation at 1 and 10 years was 88.4 ± 4.1 and 75.4 ± 7.4% for the MV repair and 97.4 ± 2.6 and 93.94 ± 4.2% for the TV repair group (ns).Endocarditis reoccurred early in 2  MV repair patients (1.9%). Freedom from reoperation due to reinfection at 1 and 10 years after MV repair was 96.6 ± 2.3 and 91.6 ± 5.4% and after TV repair 100 and 83.3 ± 9.5%.ConclusionsRepair for AV endocarditis yields excellent results. It is associated with low operative mortality and provides satisfactory early and long-term survival and favorable freedom from recurrent endocarditis and repeat operation. It should be considered as the primary surgical option in these patients, and AV replacement should be performed only in cases of severe AV destruction that renders repair techniques impossible.
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44 AV replacement
45 AVE
46 ConclusionsRepair
47 MV repair
48 MV repair patients
49 ObjectivesWe
50 active infective endocarditis
51 annular plication
52 annular reconstruction
53 annuloplasty
54 artificial devices
55 cases
56 center experience
57 characteristics
58 destruction
59 devices
60 early failure
61 early mortality
62 endocarditis
63 excellent results
64 experience
65 failure
66 favorable freedom
67 freedom
68 group
69 infective endocarditis
70 leaflet resection
71 leaflets
72 long-term results
73 long-term survival
74 low operative mortality
75 mitral
76 mortality
77 operation
78 operative mortality
79 options
80 patient underwent repair
81 patient years
82 patients
83 period
84 perioperative characteristics
85 plication
86 predictors
87 primary surgical option
88 probability
89 probability of survival
90 rate
91 reconstruction
92 recurrence
93 recurrent endocarditis
94 reinfection
95 reoperation
96 repair
97 repair group
98 repair patients
99 repair techniques
100 replacement
101 resection
102 results
103 single-center experience
104 surgical options
105 survival
106 survival rate
107 technique
108 total
109 tricuspid valve repair
110 underwent repair
111 valve endocarditis
112 valve repair
113 valve-related reoperation
114 vegetectomy
115 years
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