Aorto-mitral curtain reconstruction in invasive double-valve endocarditis: mid-term outcomes
BackgroundInvasive double-valve endocarditis with structural damage (abscess or perforation) of the aorto-mitral curtain is a relatively rare but fatal diagnosis requiring complex surgical reconstruction. This study presents the short-term and mid-term outcomes from a single center.MethodsFrom 2014...
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| Format: | Article |
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Frontiers Media S.A.
2023-05-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2023.1154129/full |
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| author | Martin Vobornik Salifu Timbilla Jan Gofus Petr Smolak James Lago Chek Marek Pojar Eva Cermakova Pavel Zacek Jan Vojacek |
| author_facet | Martin Vobornik Salifu Timbilla Jan Gofus Petr Smolak James Lago Chek Marek Pojar Eva Cermakova Pavel Zacek Jan Vojacek |
| author_sort | Martin Vobornik |
| collection | DOAJ |
| description | BackgroundInvasive double-valve endocarditis with structural damage (abscess or perforation) of the aorto-mitral curtain is a relatively rare but fatal diagnosis requiring complex surgical reconstruction. This study presents the short-term and mid-term outcomes from a single center.MethodsFrom 2014 to 2021, 20 patients with double-valve endocarditis with structural damage of the aorto-mitral curtain underwent surgical reconstruction (Hemi-Commando procedure n = 16 and Commando procedure n = 4). Data were obtained retrospectively.ResultsIn 13 cases, the procedure was a reoperation. The mean cardiopulmonary bypass time was 239 ± 47 min and the mean cross-clamp time was 186 ± 32 min. Concomitant procedures were tricuspid valve repair in two, coronary revascularization in one, closure of a ventricular septal defect in one and hemiarch (using circulatory arrest) in one patient. Eleven patients (55%) required surgical revision for bleeding. Thirty-day mortality was 30% (6 patients)—3 patients from the Hemi-Commando group (19%) and 3 patients from the Commando group (75%). Overall survival at 1, 3 and 5 years was 60%, 50% and 45% respectively. Reoperation was required by 4 patients. Freedom from reoperation at 1, 3 and 5 years was 86%, 71% and 71% respectively.ConclusionDespite the high postoperative morbidity and mortality, complex surgical reconstruction of the aorto-mitral continuity of patients with double-valve endocarditis represents the only real chance for survival. Mid-term outcomes are acceptable, but strict follow-up is required due to the risk of valve failure. |
| first_indexed | 2024-04-09T13:29:39Z |
| format | Article |
| id | doaj.art-6d3b0b2d1c32442e9a2abdd59c202dd8 |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-04-09T13:29:39Z |
| publishDate | 2023-05-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-6d3b0b2d1c32442e9a2abdd59c202dd82023-05-10T05:08:07ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2023-05-011010.3389/fcvm.2023.11541291154129Aorto-mitral curtain reconstruction in invasive double-valve endocarditis: mid-term outcomesMartin Vobornik0Salifu Timbilla1Jan Gofus2Petr Smolak3James Lago Chek4Marek Pojar5Eva Cermakova6Pavel Zacek7Jan Vojacek8Department of Cardiac Surgery, Faculty of Medicine and University Hospital in Hradec Kralove, Charles University, Hradec Kralove, CzechiaDepartment of Cardiac Surgery, Faculty of Medicine and University Hospital in Hradec Kralove, Charles University, Hradec Kralove, CzechiaDepartment of Cardiac Surgery, Faculty of Medicine and University Hospital in Hradec Kralove, Charles University, Hradec Kralove, CzechiaDepartment of Cardiac Surgery, Faculty of Medicine and University Hospital in Hradec Kralove, Charles University, Hradec Kralove, CzechiaDepartment of Cardiac Surgery, Faculty of Medicine and University Hospital in Hradec Kralove, Charles University, Hradec Kralove, CzechiaDepartment of Cardiac Surgery, Faculty of Medicine and University Hospital in Hradec Kralove, Charles University, Hradec Kralove, CzechiaDepartment of Medical Biophysics, Faculty of Medicine Hradec Kralove, Charles University, Hradec Kralove, CzechiaDepartment of Cardiac Surgery, Faculty of Medicine and University Hospital in Hradec Kralove, Charles University, Hradec Kralove, CzechiaDepartment of Cardiac Surgery, Faculty of Medicine and University Hospital in Hradec Kralove, Charles University, Hradec Kralove, CzechiaBackgroundInvasive double-valve endocarditis with structural damage (abscess or perforation) of the aorto-mitral curtain is a relatively rare but fatal diagnosis requiring complex surgical reconstruction. This study presents the short-term and mid-term outcomes from a single center.MethodsFrom 2014 to 2021, 20 patients with double-valve endocarditis with structural damage of the aorto-mitral curtain underwent surgical reconstruction (Hemi-Commando procedure n = 16 and Commando procedure n = 4). Data were obtained retrospectively.ResultsIn 13 cases, the procedure was a reoperation. The mean cardiopulmonary bypass time was 239 ± 47 min and the mean cross-clamp time was 186 ± 32 min. Concomitant procedures were tricuspid valve repair in two, coronary revascularization in one, closure of a ventricular septal defect in one and hemiarch (using circulatory arrest) in one patient. Eleven patients (55%) required surgical revision for bleeding. Thirty-day mortality was 30% (6 patients)—3 patients from the Hemi-Commando group (19%) and 3 patients from the Commando group (75%). Overall survival at 1, 3 and 5 years was 60%, 50% and 45% respectively. Reoperation was required by 4 patients. Freedom from reoperation at 1, 3 and 5 years was 86%, 71% and 71% respectively.ConclusionDespite the high postoperative morbidity and mortality, complex surgical reconstruction of the aorto-mitral continuity of patients with double-valve endocarditis represents the only real chance for survival. Mid-term outcomes are acceptable, but strict follow-up is required due to the risk of valve failure.https://www.frontiersin.org/articles/10.3389/fcvm.2023.1154129/fullinfective endocarditisaorto-mitral continuityintervalvular fibrosacommando procedurehemi-commando procedure |
| spellingShingle | Martin Vobornik Salifu Timbilla Jan Gofus Petr Smolak James Lago Chek Marek Pojar Eva Cermakova Pavel Zacek Jan Vojacek Aorto-mitral curtain reconstruction in invasive double-valve endocarditis: mid-term outcomes Frontiers in Cardiovascular Medicine infective endocarditis aorto-mitral continuity intervalvular fibrosa commando procedure hemi-commando procedure |
| title | Aorto-mitral curtain reconstruction in invasive double-valve endocarditis: mid-term outcomes |
| title_full | Aorto-mitral curtain reconstruction in invasive double-valve endocarditis: mid-term outcomes |
| title_fullStr | Aorto-mitral curtain reconstruction in invasive double-valve endocarditis: mid-term outcomes |
| title_full_unstemmed | Aorto-mitral curtain reconstruction in invasive double-valve endocarditis: mid-term outcomes |
| title_short | Aorto-mitral curtain reconstruction in invasive double-valve endocarditis: mid-term outcomes |
| title_sort | aorto mitral curtain reconstruction in invasive double valve endocarditis mid term outcomes |
| topic | infective endocarditis aorto-mitral continuity intervalvular fibrosa commando procedure hemi-commando procedure |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2023.1154129/full |
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