title: Outcomes in aortic and mitral valve replacement with intervalvular fibrous body reconstruction.
abstract: BACKGROUND
  Surgery for intervalvular fibrous body reconstruction in aortic and mitral valve replacement is a complex operation, although mandatory in some circumstances. The long-term result of this operation remains unknown. The objective of this study was to analyze the outcomes of this technique.
  
  
  METHODS
  A descriptive and retrospective study was carried out to analyze operative morbidity and mortality in fibrous body reconstruction with the "David technique" and to evaluate the midterm and long-term results regarding durability and survival.
  
  
  RESULTS
  A total of 40 consecutive patients underwent the David technique between 1997 and 2014. The mean age was 58 ± 15 years and 62.5% were male. The indications were active endocarditis with paravalvular and fibrous body abscesses in 26 patients (group A) and massive calcification of the intervalvular fibrous body in 14 patients (group B). Mean European system for cardiac operative risk evaluation I predicted risk of mortality was 36 ± 24 and 16 ± 15, respectively. The hospital mortality rate was 15.3% in group A and 7.1% in group B. Survival rate after 1, 5, and 10 years was 65.4%, 57.7%, and 50% for group A and 92.9%, 85.7%, and 78.6% for group B. Freedom from reoperation at 1, 5, and 10 years was 92.3%, 84.6%, and 76.9% for group A and 90.9%, 90.9%, and 90.9% for group B. Mean follow-up was 53 ± 8 months.
  
  
  CONCLUSIONS
  Although this complex operation is associated with high perioperative mortality, the long-term results are acceptable in patients where there are not suitable alternative procedures.
authors.affiliation: Cardiac Surgery Department, Hospital Universitario 12 de Octubre, Madrid, Spain. Electronic address: apforteza@yahoo.es.
authors.forename: Alberto
authors.initials: A
authors.lastname: Forteza
authors.affiliation: Cardiac Surgery Department, Hospital Universitario 12 de Octubre, Madrid, Spain.
authors.forename: Jorge
authors.initials: J
authors.lastname: Centeno
authors.affiliation: Cardiac Surgery Department, Hospital Universitario 12 de Octubre, Madrid, Spain.
authors.forename: Victor
authors.initials: V
authors.lastname: Ospina
authors.affiliation: Cardiology Department, Hospital Universitario Quiron, Madrid, Spain.
authors.forename: Inés García
authors.initials: IG
authors.lastname: Lunar
authors.affiliation: Cardiology Department, Hospital Universitario 12 de Octubre, Madrid; Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain.
authors.forename: Violeta
authors.initials: V
authors.lastname: Sánchez
authors.affiliation: Cardiac Surgery Department, Hospital Universitario 12 de Octubre, Madrid, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Pérez
authors.affiliation: Cardiac Surgery Department, Hospital Universitario 12 de Octubre, Madrid, Spain.
authors.forename: María Jesús
authors.initials: MJ
authors.lastname: López
authors.affiliation: Cardiac Surgery Department, Hospital Universitario 12 de Octubre, Madrid, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Cortina
mesh_terms: D001021:Aortic Valve / Q000601:surgery*; D004696:Endocarditis / Q000601:surgery*; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D011379:Prognosis; D012008:Recurrence; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome