Extensive infective endocarditis of the aortic root and the aortic-mitral continuity: a mitral valve sparing approach†.
OBJECTIVE
Severe cases of infective endocarditis (IE) of the aortic valve can cause aortic root destruction and affect the surrounding structures, including the aortic-mitral continuity, the anterior mitral valve leaflet and the roof of the left atrium. Reconstruction after resection of all infected tissue remains challenging. We describe our surgical approach and the mid-term results.


METHODS
Between January 2004 and December 2015, 35 patients underwent surgery for extensive IE of the aortic valve with destruction of the aortic root, the aortic-mitral continuity and the mitral valve. Mean age was 60.4 ± 13.7; 26/35 (74%) patients had prosthetic valve endocarditis. Four patients were in critical preoperative state. Median EuroSCORE II was 18.0% [interquartile range (IQR) 11.0-26.7].


RESULTS
Aortic root replacement was performed in 32 (91%) patients. The remaining patients underwent aortic valve replacement. Reconstruction of the aortic-mitral continuity and the roof of the left atrium were performed using a folded pericardial patch. In 28 patients (80%), mitral valve repair was performed. Postoperative mechanical circulatory support, acute kidney failure and surgical re-exploration were seen in 5 (16%), 10 (31%) and 4 (13%) patients, respectively. Early survival rate was 77% (27 patients). During a median follow-up of 29.8 months (IQR 6.4-62.9), 7 (26%) patients required reintervention (3-42 months after surgery); 4 were due to mitral incompetence, early in our experience.


CONCLUSIONS
Extensive IE of the aortic root with destruction of the surrounding tissues remains a complex disease with high morbidity and mortality rates. Our technique allows native mitral valve preservation but is technically challenging.
Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands.
Anton
A
Tomšic
Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands.
Adriaan W
AW
Schneider
Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands.
Meindert
M
Palmen
Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands.
Thomas J
TJ
van Brakel
Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands.
Michel I M
MIM
Versteegh
Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands.
Robert J M
RJM
Klautz
D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D004697:Endocarditis, Bacterial / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D059351:Organ Sparing Treatments / Q000379:methods* / Q000401:mortality; D019651:Plastic Surgery Procedures / Q000379:methods* / Q000401:mortality; D012189:Retrospective Studies
Aortic root abscess; Endocarditis; Mitral valve repair