title: Double valve replacement and reconstruction of the intervalvular fibrous body in patients with active infective endocarditis.
abstract: OBJECTIVE
  Destruction of the intervalvular fibrous body, though uncommon, occurs due to paravalvular abscess formation following active infective endocarditis. This warrants a highly complex operation involving radical surgical debridement of the intervalvular fibrous body, followed by double valve (aortic and mitral) replacement with patch reconstruction of the anterior mitral annulus, the left ventricular outflow tract and the left atrial roof. The objective of this study was to review the early and mid-term outcomes in patients undergoing this operation.
  
  
  METHODS
  A total of 25 patients underwent double valve replacement with reconstruction of the intervalvular fibrous body for extensive infective endocarditis between January 1999 and March 2012. The mean age was 64.3 ± 10.5 years. Most of the patients (60%) were in New York Heart Association Class III-IV, 12% and in cardiogenic shock. Associated comorbidities like acute renal insufficiency and cerebrovascular accidents were observed in 40 and 20% of patients, respectively. Twenty patients had previous heart valve surgeries. The logistic EuroSCORE predicted risk of mortality was 55.1 ± 22.9%.
  
  
  RESULTS
  Overall, 30-day mortality was 32%. Postoperative complications like low cardiac output, stroke and acute renal failure developed in 16, 28 and 56%, respectively. Thirty-two percent of patients required re-exploration for bleeding. Nine patients were alive at a mean follow-up of 406 days (0-8 years). The 2- and 5-year survivals were 37.0 ± 11.1 and 24.6 ± 12.5%, respectively.
  
  
  CONCLUSIONS
  Double valve replacement with reconstruction of the intervalvular fibrous body for infective endocarditis is a complex, technically challenging operation associated with high perioperative morbidity and mortality. Nevertheless, being the only option available for such complex disease, it should be performed in these patients who, otherwise, face 100% mortality.
authors: Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany.
authors: Piroze M
authors: PM
authors: Davierwala
authors: Christian
authors: C
authors: Binner
authors: Sreekumar
authors: S
authors: Subramanian
authors: Maximilian
authors: M
authors: Luehr
authors: Bettina
authors: B
authors: Pfannmueller
authors: Christian
authors: C
authors: Etz
authors: Pascal
authors: P
authors: Dohmen
authors: Martin
authors: M
authors: Misfeld
authors: Michael A
authors: MA
authors: Borger
authors: Friedrich W
authors: FW
authors: Mohr
mesh_terms: D000328:Adult; D000368:Aged; D004696:Endocarditis / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D006351:Heart Valves / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies
keywords: Aortic valve replacement; Endocarditis; Mitral valve replacement