Thorac Cardiovasc Surg 2023; 71(S 01): S1-S72
DOI: 10.1055/s-0043-1761820
Tuesday, 14 February
Potpourri aus der Thorax-Herz-Gefäß-Chirurgie II

Surgical Treatment Options for Prosthetic Valve Endocarditis after Aortic Valve Procedures

Authors

  • P. Benedikt

    1   Kepler Universitätsklinikum, Med Campus III., Linz, Austria

  • M. Hohn

    1   Kepler Universitätsklinikum, Med Campus III., Linz, Austria

  • A. Zierer

    1   Kepler Universitätsklinikum, Med Campus III., Linz, Austria
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Background: Prosthetic valve endocarditis (PVE) is a severe complication of cardiac valve replacement that carries a high mortality of 20 to 30%. Depending on the extent of tissue destruction different surgical treatment options are available. The aim of the study is to share our experience with this partly challenging surgery including different techniques of aortic root reconstruction or replacement.

Method: We enrolled 136 patients who were treated for infective endocarditis between February 2017 and July 2022. Of these, 23 (17%) had PVE aged 69 years (IQR [11.5], female patients 26%, EuroSCORE II 12.07 [23.5]). Three patients underwent their third valve procedure. Preoperative, intraoperative, and postoperative parameters and complications including pathogen spectrum and type and duration of antibiotic therapy were studied. First operation was biological aortic valve replacement (AVR) in 15 (65%), mechanical AVR in 6 (26%) and transcatheter aortic valve replacement (TAVI in 2 (9%) patients.

Results: In median PVE occurred 44 (IQR [11.7]) months after AVR or TAVI. Eight patients (35%) had early PVE (<12 months). Full root replacement was performed in 16 (70%) patients (3 aortic homografts, 5 porcine full root prostheses, 1 mechanical, 3 biological composite conduits, and 4 bovine pericardial bioconduits). The rest was treated with biological AVR. Four patients underwent concomitant CABG. 30-day mortality was 13%. One patient had reexploration owing to bleeding. Three patients needed a pacemaker. Ten months after surgery, an ICD CRT implantation was necessary in one patient. The rest of the patients had an uneventful course with a median follow-up time of 36 months for 35% of the patients.

Conclusion: After an initial elevated morbidity and mortality rate, reoperations of PVE show consistent good results. Even challenging aortic root replacements can be performed satisfactorily. Alongside meticulous surgical planning, antibiogram conducted long-term antibiotic therapy is mandatory.



Publication History

Article published online:
28 January 2023

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