title: Repair versus replacement of the aortic valve in active infective endocarditis.
abstract: OBJECTIVE
  Aortic valve repair has advantages over replacement in stable aortic regurgitation. It is unclear whether this is similar in active endocarditis.
  
  
  METHODS
  From January 2000 to July 2009, 100 patients (age 54.9±15.1 years) underwent surgery for aortic valve endocarditis. Thirty-three patients were treated by valve repair (I) and 67 underwent valve replacement (II: 51 biologic, 10 mechanical valves, 6 Ross operations). In Group I, cusp and root lesions were treated by autologous pericardial patches. A root abscess was present in 32 cases (I: 27%, II 34%; P=0.82). Concomitant procedures (n=49) were mitral repair (I: 10, II: 11; P=0.12) and coronary bypass (I: 4, II: 11; P=0.77). All patients were followed. Cumulative follow-up was 268 patient-years (mean 2.7±3.0 years). In a retrospective analysis, we analysed the outcome.
  
  
  RESULTS
  Hospital mortality was 15% (I: 9%, II: 18%; P=0.37). Survival at 5 years was significantly better after repair (I: 88%, II 65%; P=0.047). Ten patients were reoperated (I: 35%, II: 10%; P=0.021) between 1 month and 5 years postoperatively. Actuarial freedom from aortic regurgitation of grade II or higher was 80% at 5 years (I: 66%, II: 87%; P=0.066). In Group I, this was influenced by aorto-ventricular (AV) morphology (tricuspid 80%, bicuspid 50%; P=0.0045). Freedom from reoperation in reconstructed tricuspid valves (n=20) was 87% at 5 years, which was identical to Group II (P=0.40). At 5 years, freedom from thromboembolic events was 93% (I: 100%, II: 90%; P=0.087) and that from bleeding complications was 100%.
  
  
  CONCLUSIONS
  AV repair for active endocarditis seems to lead to better survival compared with replacement. The use of large patches in combination with bicuspid anatomy results in increased risk of late failure.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery,  University Hospital of Saarland, Homburg,  Germany.
authors.forename: Katharina
authors.initials: K
authors.lastname: Mayer
authors.forename: Diana
authors.initials: D
authors.lastname: Aicher
authors.forename: Susanne
authors.initials: S
authors.lastname: Feldner
authors.forename: Takashi
authors.initials: T
authors.lastname: Kunihara
authors.forename: Hans-Joachim
authors.initials: HJ
authors.lastname: Schäfers
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000382:microbiology / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D004697:Endocarditis, Bacterial / Q000150:complications / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010496:Pericardium / Q000637:transplantation*; D011183:Postoperative Complications / Q000453:epidemiology; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult