title: Surgical treatment of aortic valve endocarditis with left ventricular-aortic discontinuity.
abstract: BACKGROUND
  The periannular expansion of infection is a serious complication of infective endocarditis associated with high morbidity and mortality. The present study evaluates the results of aortic annular reconstruction in active infective endocarditis with left ventricular-aortic discontinuity.
  
  
  METHODS
  Left ventricular-aortic discontinuity was diagnosed by echocardiography in 25 (21 men, 4 female; mean age 60.2 ± 13.2 years) of 269 patients who underwent surgery for active native or prosthetic aortic valve endocarditis between January 2001 and October 2011. Seventeen (68%) and 8 (32%) patients had native and prosthetic valve endocarditis, respectively. Aortic root abscesses were radically debrided in all patients. The aortic annulus was reconstructed using autologous pericardium in 20 patients and a Dacron patch in 2. Isolated aortic valves were replaced with a bioprosthesis in 9 (36%) patients and a mechanical prosthesis in 13 (52%). Mechanical composite grafts were implanted in 3 (12%) patients. The mean follow-up was 29.1 ± 23.6 months and complete.
  
  
  RESULTS
  Thirty-day mortality was 20% (n = 5). Survival at 3 years was 80% ± 8% with no significant difference between native and prosthetic valve endocarditis (log-rank, p = 0.69). Endocarditis did not recur during follow-up.
  
  
  CONCLUSIONS
  Despite procedural progress, surgery for aortic valve endocarditis with left ventricular-aortic discontinuity remains associated with significant in-hospital mortality, but mid-term survival after the perioperative period is good. Annular reconstruction with a pericardial patch is technically safe.
authors.affiliation: Department of Cardiac Surgery, University Hospital Heidelberg, Heidelberg, Germany. takahashi-cvs@hotmail.co.jp
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Takahashi
authors.forename: Rawa
authors.initials: R
authors.lastname: Arif
authors.forename: Klaus
authors.initials: K
authors.lastname: Kallenbach
authors.forename: Ursula
authors.initials: U
authors.lastname: Tochtermann
authors.forename: Matthias
authors.initials: M
authors.lastname: Karck
authors.forename: Arjang
authors.initials: A
authors.lastname: Ruhparwar
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D004452:Echocardiography; D004697:Endocarditis, Bacterial / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D006350:Heart Valve Prosthesis / Q000009:adverse effects* / Q000382:microbiology; D006352:Heart Ventricles / Q000601:surgery*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D010496:Pericardium / Q000637:transplantation; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends