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Aortic valve repair in endocarditis: scope and results

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Indian Journal of Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

Abstract

Purpose

Infective endocarditis (IE) remains a prevalent and life-threatening disease. The choice to repair or replace the infected valve still remains a matter of debate, especially in aortic valve (AV) infections. We retrospectively analyze our two decades of experience in aortic valve repair (AVr) in IE. Long-term outcomes are described with particular attention to the impact of valve configuration and the use of patch techniques.

Methods

From September 1998 to June 2017, 42 patients underwent AVr in a single center for IE. Techniques include leaflet patch repair and resuspension and aortic annulus stabilization.

Results

Hospital mortality was 2.4% (n = 1). The median follow-up was 90.6 months. Survival was 89 ± 9.4% and 76.6 ± 16% at 5 and 10 years, respectively, with no significant differences between tricuspid aortic valve (TAV) and bicuspid aortic valve (BAV). Freedom from reoperation was 100% and 92.9 ± 7.1% in TAV and 81.8 ± 18.2% and 46.8 ± 28.8% in BAV at 5 and 10 years, respectively (TAV vs BAV, p = 0.02). BAV, degree of preoperative aortic insufficiency, and AVr including patch were factors predicting a higher risk of reoperation during the follow-up.

Conclusion

In our experience, AVr is a safe, feasible, and efficient choice in selected patients with healed or active IE. Durability of the repair is excellent in patients with limited lesions and in patients with TAV even with patch repair. Reoperations occurred principally in patients with BAV and severe preoperative AI, in whom patch repair was performed. In those patients, we actually recommend to replace the valve in case of active endocarditis.

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Acknowledgments

The authors thank Corinne Coulon for her outstanding work as data manager.

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Authors and Affiliations

  1. Department of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Av Hippocrate 10, 1200, Brussels, Belgium

    Silvia Solari, Saadallah Tamer, Gaby Aphram, Stefano Mastrobuoni, Emiliano Navarra, Philippe Noirhomme, Alain Poncelet, Parla Astarci, Jean Rubay, Gébrine El Khoury & Laurent De Kerchove

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  1. Silvia Solari
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  2. Saadallah Tamer
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  3. Gaby Aphram
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  4. Stefano Mastrobuoni
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  6. Philippe Noirhomme
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  7. Alain Poncelet
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  10. Gébrine El Khoury
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  11. Laurent De Kerchove
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Correspondence to Silvia Solari.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent was obtained from all individual participants included in the study

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Solari, S., Tamer, S., Aphram, G. et al. Aortic valve repair in endocarditis: scope and results. Indian J Thorac Cardiovasc Surg 36 (Suppl 1), 104–112 (2020). https://doi.org/10.1007/s12055-019-00831-0

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  • DOI: https://doi.org/10.1007/s12055-019-00831-0

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