Surgical Experience of Reconstruction of the Annular and the Intervalvular Fibrous Skeleton for Active Infective Endocarditis

Sung, Ki Ick; Park, Pyo Won

Abstract

BACKGROUND AND OBJECTIVES: The treatment for active infective endocarditis (IE) with a paravalvular abscess results in a high morbidity and mortality. Recently, some good results with a reconstruction of the annulus or fibrous skeleton in active IE have been published. However, there are few papers on this subject reported in Korea.
SUBJECTS AND METHODS
The hospital records of 29 patients who had undergone surgery for active IE with a paravalvular abscess from Mar. 1995 to Jun. 2002 were retrospectively reviewed. The mean age was 43.8 +/-16.9 (range : 13-69) years. The NYHA functional class was either III or IV in 11 cases (37.9%) and prosthetic valve endocarditis was present in 8 cases (27.6%). The mean duration of preoperative antibiotic treatment was 13.3+/-11.9 days.
RESULTS
The aortic annulus was reconstructed in 7 patients, an aortic annulus+the aorto-mitral continuity was done in 8 cases, an aortic annulus+mitral annulus+aorto-mitral continuity was done in 1 case, and a mitral annulus was done in 13 cases. There was one (3.4%) early death due to a non-cardiac cause. The postoperative complications were as follows : additional surgery due to bleeding in 3 cases (10.3%), mediastinitis in 1 case (3.4%), a complete atrioventricular block in 1 case (3.4%), and a cerebral hemorrhage in 2 cases (6.9%) who had had a history of cerebral embolism. All patients (100%) were followed up with a mean follow-up duration of 22.0+/-19.2 months. There was 1 late death (3.6%) and 2 additional procedures including one recurrence.
CONCLUSION
Reconstruction of the annulus and intervalvular fibrous skeleton in these patients showed a relatively low morbidity and mortality, and recurrence rate. Therefore, it is recommended that these patients be treated aggressively.