HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Onnen Grauhan Miralem Pasic Charles Yankah Roland Hetzer Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Siniawski, H. Articles by Hetzer, R. Search for Related Content PubMed PubMed Citation Articles by Siniawski, H. Articles by Hetzer, R. Related Collections Cardiac - other

Eur J Cardiothorac Surg 2005;27:434-440
© 2005 Elsevier Science NL

Aortic root abscess and secondary infective mitral valve disease: results of surgical endocarditis treatment

Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353 Berlin, Germany

Received 17 September 2004; received in revised form 16 November 2004; accepted 1 December 2004.

^* Corresponding author. Tel: +49 30 4593 2012; fax: +49 30 4593 1003. (E-mail: siniawski{at}dhzb.de).

Objective: Mortality in active infective endocarditis (AIE) is substantial and reinfection can strongly influence outcome. Assessment of factors influencing mortality is important. We studied 108 (33%) patients suffering from root abscess out of a total of 327 AIE patients admitted to the Deutsches Herzzentrum Berlin for surgical treatment between 1996 and 2003. Among them were 53 (25.5% of all patients) who were diagnosed as having secondary infective mitral valve disease (SMVD). Mean age was 53±14.2 years; there were 37 men and 16 women. Methods: Risk factors were assessed on the basis of clinical, hemodynamic, echocardiographic and surgical information. Mean follow-up was 325±251 days with complete echocardiographic examination performed in patients with double valve surgery. The differences between groups were analyzed using Student's t-test. Multivariate analysis for the whole group suffering from abscess was performed to identify independent factors influencing mortality. Results: In 19 (35.8%) patients suffering from SMVD mitral valve reconstruction was undertaken and mitral valve replacement was performed in 34 (64.2%) patients. There were 27 patients treated with a Shelhigh prosthesis: 18 with double valve replacement (both Shelhigh) and nine with an aortic Shelhigh prosthesis and concomitant mitral valve reconstruction. Homografts were used in 17 patients, with mitral reconstruction in 10 and a stented mitral prosthesis in seven. In nine cases two stented valve prostheses were used. The calculated mean Doppler gradient for homografts and Shelhigh in aortic position was 12 (±5.7) and 15 (±4.6), respectively (NS). The following predisposing factors for mortality were assessed: severe damage of aortic annulus (OR 4.65, CI 1.22–17.1, P=0.0159); septic shock (OR 3.44, CI 0.85–13.9, P=0.07) and poor ejection fraction (<40%), and dilated LV. Conclusions: Excessive mortality reaching 29% was noted in patients suffering from AIE with aortic ring abscess and SMVD requiring double valve surgery. Double valve surgery with semi-stented Dacron-free valve prostheses is associated with a low rate of reinfection and good function of the implants. The most potent independent risk factors for death were septic shock and severe aortic root destruction.

Key Words: Double valve endocarditis • Destructive endocarditis • Secondary mitral valve endocarditis • Jet lesion • Superstentless valve substitute • Aortic root abscess

This article has been cited by other articles:

				A. M. Sheikh, A. M. Elhenawy, M. Maganti, S. Armstrong, T. E. David, and C. M. Feindel Outcomes of double valve surgery for active infective endocarditis J. Thorac. Cardiovasc. Surg., July 1, 2009; 138(1): 69 - 75. [Abstract] [Full Text] [PDF]

				R. Atoui, T. Hijal, R. Fraser, and D. Shum-Tim Acute rupture of both papillary muscles after aortic valve replacement for infective endocarditis. J. Thorac. Cardiovasc. Surg., May 1, 2009; 137(5): 1275 - 1276. [Full Text] [PDF]

				M. Musci, H. Siniawski, and R. Hetzer Shelhigh bioprosthesis in active infective endocarditis. J. Thorac. Cardiovasc. Surg., May 1, 2009; 137(5): 1295 - 1296. [Full Text] [PDF]

				T. Carrel, F. S. Schoenhoff, and D. Cameron Reply to the Editor J. Thorac. Cardiovasc. Surg., May 1, 2009; 137(5): 1296 - 1297. [Full Text] [PDF]

				T. E. David, T. Regesta, G. Gavra, S. Armstrong, and M. D. Maganti Surgical treatment of paravalvular abscess: long-term results Eur. J. Cardiothorac. Surg., January 1, 2007; 31(1): 43 - 48. [Abstract] [Full Text] [PDF]

				T. E. David, G. Gavra, C. M. Feindel, T. Regesta, S. Armstrong, and M. D. Maganti Surgical treatment of active infective endocarditis: A continued challenge J. Thorac. Cardiovasc. Surg., January 1, 2007; 133(1): 144 - 149. [Abstract] [Full Text] [PDF]

				N. Al-Attar, R. Nottin, R. Ramadan, and A. Azmoun Translocation of the aortic valve in severe aortic root abscess. An alternative to homografts Eur. J. Cardiothorac. Surg., September 1, 2005; 28(3): 509 - 510. [Full Text] [PDF]