title: Reconstruction of fibrous skeleton: technique, pitfalls and results.
abstract: Destruction of the mitral-aortic (or mitroaortic) intervalvular fibrosa (IVF) by infective endocarditis is a marker of advanced pathology. Patients are at high risk, as they are sicker, have more comorbidities and have more advanced pathology, requiring a difficult operation that includes debriding and reconstructing the IVF. The anatomy and surgical techniques for that reconstruction are presented and discussed. Operative risk is high and remains high for the first year, before becoming equivalent to that of conventional operations for endocarditis. Current outcomes are better than in the past, but there is room for further improvement.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA petterg@ccf.org.
authors.forename: Gösta B
authors.initials: GB
authors.lastname: Pettersson
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Syed T
authors.initials: ST
authors.lastname: Hussain
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Rajesh M
authors.initials: RM
authors.lastname: Ramankutty
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Bruce W
authors.initials: BW
authors.lastname: Lytle
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Eugene H
authors.initials: EH
authors.lastname: Blackstone
mesh_terms: D001021:Aortic Valve / Q000473:pathology / Q000601:surgery; D058385:Cardiac Valve Annuloplasty / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D004696:Endocarditis / Q000150:complications*; D005355:Fibrosis / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D008943:Mitral Valve / Q000473:pathology / Q000601:surgery; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D018570:Risk Assessment
keywords: Aortic valve; Endocarditis; Intervalvular fibrosa; Mitral valve; Surgery