Surgical Treatment of Double Valve Endocarditis

Authors

  • Serpil Tas
  • Taylan Adademir
  • Eylem Yayla Tuncer
  • Arzu Antal Donmez
  • Ebru Bal Polat
  • Mehmet Aksut
  • Murat Songur
  • Altug Tuncer
  • Mesut Sismanoglu

DOI:

https://doi.org/10.1532/HSF98.2013280

Abstract

Background: We have retrospectively analyzed the results of the operations made for aortic infective endocarditis with mitral involvement in a single center in 19 years.

Methods: From May 1992 to January 2011, we have operated on 72 patients with infective endocarditis of the aortic valve with mitral valve involvement. Fifty-two patients (72.2%) were male and the mean age was 40.5 ± 15.5 (9-73) years. The blood cultures were positive in 33 patients (45.8%) and the most commonly identified microorganism was Streptococcus. Nine patients (12.5%) had prosthetic valve endocarditis. The mean duration of follow-up was 6.8 ± 4.7 (0.1-16.9) years, adding up to a total of 156.1 patient/years.

Results: A total of 155 procedures were performed on these 72 patients. The most commonly performed procedure was aortic valve replacement, in 63 patients (87.5%). Aortic annular involvement was present in 9 cases (12.5%). In-hospital mortality was seen in 13 patients (18.1%). Postoperatively, 13 (18.1%) patients had low cardiac output, 9 (12.5%) had heart block, and only 1 of them required permanent pacemaker implantation. The actuarial survival rates for 1, 5, and 10 years were 96.4% ± 2.5%, 84.4% ± 5.1%, and 77.4 ± 6.7%, respectively.

Conclusions: Double-valve endocarditis is a serious condition and the surgeon must be aware of the high rates of mortality and morbidity in these patients. Although no association was found, heart blocks and septic embolization must be handled with caution. The patients generally do well after surgery, and recurrences and reoperations decrease by the second year after operation.

References

Aranki SF, Santini F, Adams DH, et al. 1994. Aortic valve endocarditis. Determinants of early survival and late morbidity. Circulation 90(5 Pt 2):175-82.nBozbuga N, Erentug V, Erdogan HB, et al. 2004. Surgical treatment of aortic abscess and fistula. Tex Heart Inst J 31:382-6.nCarrel TP, Berdat P, Englberger L, et al. 2003. Aortic root replacement with a new stentless aortic valve xenograft conduit: preliminary hemodynamic and clinical results. J Heart Valve Dis 12:752-7.nDavid TE, Gavra G, Feindel CM, Regesta T, Armstrong S, Maganti MD. 2007. Surgical treatment of active infective endocarditis: a continued challenge. J Thorac Cardiovasc Surg 133:144-9.nDelahaye F, Célard M, Roth O, de Gevigney G. 2004. Indications and optimal timing for surgery in infective endocarditis. Heart 90:618-20.nDurack DT, Lukes AS, Bright DK. 1994. New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Duke Endocarditis Service. Am J Med 96:200-9.nGaca JG, Sheng S, Daneshmand MA, et al. 2011. Outcomes for endocarditis surgery in North America: a simplified risk scoring system. J Thorac Cardiovasc Surg 141:98-106.nGillinov AM, Diaz R, Blackstone EH, et al. 2001. Double valve endocarditis. Ann Thorac Surg 71:1874-9.nHagl C, Galla JD, Lansman SL, et al. 2002. Replacing the ascending aorta and aortic valve for acute prosthetic valve endocarditis: is using prosthetic material contraindicated? Ann Thorac Surg 74:S1781-5.nKirali K, Omeroglu SN, Mansuroglu D, Ipek G, Yakut C. 2000. Aortic root abscess with fistula formation into right ventricular myocardium. Türk Kardiyol Dern Ar? 28:647-9.nLeyh RG, Knobloch K, Hagl C, et al. 2004. Replacement of the aortic root for acute prosthetic valve endocarditis: prosthetic composite versus aortic allograft root replacement. J Thorac Cardiovasc Surg 127:1416-20.nOakley C. 2002. The mitral kissing vegetation. Eur Heart J 23:11-2.nPiper C, Hetzer R, Körfer R, Bergemann R Horstkotte D. 2002. The importance of secondary mitral valve involvement in primary aortic valve endocarditis. Eur Heart J 23:79-86.nPrendergast BD, Tornos P. 2010. Surgery for infective endocarditis: who and when? Circulation 121:1141-52.nRenzulli A, Carozza A, Romano G, et al. 2001. Recurrent infective endocarditis: a multivariate analysis of 21 years of experience. arenzul@tin.it. Ann Thorac Surg 72:39-43.nSiniawski H, Grauhan O, Hofmann M, et al. 2005. Aortic root abscess and secondary infective mitral valve disease: results of surgical endocarditis treatment. Eur J Cardiothorac Surg 27:434-40.n

Published

2014-03-14

How to Cite

Tas, S., Adademir, T., Tuncer, E. Y., Donmez, A. A., Polat, E. B., Aksut, M., Songur, M., Tuncer, A., & Sismanoglu, M. (2014). Surgical Treatment of Double Valve Endocarditis. The Heart Surgery Forum, 17(1), E28-E34. https://doi.org/10.1532/HSF98.2013280

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