Results of annular reconstruction with a pericardial patch in active infective endocarditis.
OBJECTIVE
Annular reconstruction in active infective endocarditis (IE) is technically difficult, and results in a high mortality and morbidity. The study aim was to determine the midterm results of annular reconstruction with a pericardial patch in active IE.


METHODS
A total of 57 operations was performed in 56 patients (38 men, 18 women; mean age 48.3 +/- 16.9 years) with active IE. Twenty-five cases (44%) were included in whom the preoperative NYHA class was III or IV.


RESULTS
Bovine pericardium was used in 52 cases, autologous pericardium in three, and bovine + autologous pericardium in two. The aortic annulus was reconstructed in 18 cases, combined with aortomitral continuity in 13 cases, and both aortic and mitral annulus were combined with aortomitral continuity in three cases. The mitral annulus was reconstructed in 21 cases, and the complete cardiac skeleton was reconstructed in one case. There were three operative deaths. Postoperative complications included reexploration due to bleeding in two cases, mediastinitis in one case, complete atrioventricular block in five cases, and cerebral hemorrhage in six cases. The follow up was 93% complete (52/56); the mean duration of follow up was 45.1 +/- 32.6 months (range: 2-138 months). There were two late deaths, at three and eight months postoperatively. Endocarditis recurred five times in four patients. Re-do surgery was performed in four cases due to endocarditis recurrence in three patients at two, three, and 29 months after surgery, respectively, and to a pseudoaneurysm in one patient at one month postoperatively. The mean survival at two years was 91 +/- 3.9%; the two-year event-free survival was 82 +/- 5.4%.


CONCLUSIONS
Annular reconstruction with a pericardial patch in active IE can be performed safely, and showed good durability at the mid-term follow up examination.
Shinn
Sung Ho
SH
Department of Thoracic and Cardiovascular Surgery, Hanyang University Guri Hospital, College of Medicine, University of Hanyang, Guri, Gyeonggi-do, Seoul, Korea.
Sung
Kiick
K
Park
Pyo Won
PW
Lee
Young Tak
YT
Kim
Wook Sung
WS
Yang
Ji-Hyuk
JH
Jun
Tae-Gook
TG
Lee
Sang-Chol
SC
Park
Seung Woo
SW
D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D001021:Aortic Valve / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D002417:Cattle; D004696:Endocarditis / Q000382:microbiology / Q000401:mortality* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D010496:Pericardium / Q000637:transplantation*; D012189:Retrospective Studies; D013211:Staphylococcus aureus / Q000472:pathogenicity; D015996:Survival Rate; D014183:Transplantation, Heterologous; D016896:Treatment Outcome; D034363:Viridans Streptococci / Q000472:pathogenicity; D055815:Young Adult