Surgical Management Of Aortic Root Abscess And Intervalvular Fibrous Body Reconstruction In Acute Endocarditis
Matteo Pettinari, Gabriele Tamagnini, Roger Devotini, Christiaan Vankerrebroeck, Robert Dion, Herbert Gutermann.
Ziekenhuis Oost Limburg, Genk, Belgium.
Patient Demographics: Between October 2008 and March 2016, 54 patients underwent operation for valve endocarditis, of whom 9 had aortic root abscess extending to the mitral-aortic intervalvular fibrous body. The infected valve was native in 4 patients and prosthetic in 5 patients. Patients' age and EuroSCORE II-predicted risk of mortality were 65±15 years and 24.4±24.1%, respectively.
Relevant History: all patients were diagnosed by transesophageal echocardiography. Surgery was performed after two to five day of properly oriented antibiotics therapy
Pre-Operative Plan: In al patients the complete removal of the infected tissue was the first goal. The reconstruction was planned using bovine pericardial patch associated with full root aortic replacement by a Freestyle stentless valve.
Discussion of what was actually done and the challenges, deaths and complications encountered. (Unless case is still pending): Thirty-day and 3 years survival were 77.8±13.9% and 66.7±15.7% respectively. There was no survival difference between patients with native or prosthetic valve endocarditis. One patient underwent reoperation because of an early recurrence of infection with a second reconstruction of the aortic intervalvular fibrous body and implantation of a new stentless full root. At follow-up the mean gradient over the aortic prosthesis was 5.4 ± 1.4 mmHg.
The surgical treatment of aortic root abscess with involvement of the mitral aortic intervalvular fibrous body remains a challenge with relatively high perioperative morbidity and mortality, although long-term survival is satisfactory and the rate of recurrence of endocarditis is low.
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