title: Treatment of prosthetic valve endocarditis complicated by destruction of the aortic annulus.
abstract: OBJECTIVE
  It has been reported that surgical treatment for prosthetic valve endocarditis complicated by destruction of the aortic annulus is associated with high mortality and morbidity. The aim of this study was to evaluate the efficacy of our surgical strategy for this situation.
  
  
  METHODS
  Between October 2003 and April 2009, eight patients (mean age 68.6 years) with prosthetic valve endocarditis complicated by destruction of the aortic annulus were surgically treated at our hospital. We use a relatively simple procedure consisting of a patch plasty of the abscess cavity in addition to complete removal of the infected tissue of the abscess cavity followed by standard aortic valve replacement. All patients had active endocarditis and were in New York Heart Association functional class III or IV. Preoperative echocardiography revealed that four patients had moderate or severe aortic regurgitation, and two had mitral valve endocarditis as well.
  
  
  RESULTS
  There were no operative deaths (≤30 days). Cardiac complications included paroxysmal atrial fibrillation in three patients and transient atrioventricular block in one. One patient died of multiple organ failure 66 days after the surgery. The overall in-hospital mortality was 12.5%. Patients were followed-up for 6-49 months (mean 31 months). There was no recurrent prosthetic valve endocarditis. One patient required reoperation (mitral annuloplasty and redo aortic valve replacement). There were two late deaths: lung cancer in one and multiple organ failure related to pneumonia after the aforementioned redo operation in the other.
  
  
  CONCLUSIONS
  Our simple procedure for complicated prosthetic valve endocarditis yielded excellent early and midterm outcomes.
authors.affiliation: Division of Cardiovascular Surgery, Tominaga Hospital, Osaka, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Okamoto
authors.forename: Kenji
authors.initials: K
authors.lastname: Minakata
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Yunoki
authors.forename: Masatake
authors.initials: M
authors.lastname: Katsu
authors.forename: Shin-ichiro
authors.initials: S
authors.lastname: Chino
authors.forename: Masahiko
authors.initials: M
authors.lastname: Matsumoto
mesh_terms: D000038:Abscess / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery*; D003646:Debridement; D020878:Device Removal; D004697:Endocarditis, Bacterial / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D012086:Reoperation; D013212:Staphylococcus epidermidis / Q000302:isolation & purification; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography