Valve repair in acute endocarditis

Valve repair in acute endocarditis

G Dreyfus, A Serraf, VA Jebara, A Deloche, S Chauvaud, JP Couetil and A Carpentier
Department of Cardiovascular Surgery, Hopital Broussais, Paris, France.

Forty patients were operated on in the early phase of active endocarditis between 1980 and 1988. Indications for operation were heart failure (30 patients), severe valvular regurgitation (4), uncontrolled sepsis (2), septic emboli (3), and other (1 patient). Time between onset of endocarditis symptoms and operation ranged from 12 to 45 days (mean, 30 days). The aortic valve was involved in 3 patients; the mitral valve, in 28; both valves, in 7; and the tricuspid valve, in 2. There was no previous underlying valve pathology in 40%. Lesions found were cusp perforation (17 patients), annular abscess (4), vegetation (13), and chordal rupture (22). Positive blood cultures were found in 30 patients (75%). Bacterial findings were Streptococcus in 12 patients (30%), Staphylococcus in 15 (37.5%), gram-negative in 3 (7.5%), and unknown in 10 (25%). Criteria to perform valve repair were adequate antibiotic therapy for at least 1 week and large excision of all macroscopically involved tissues. In all cases, Carpentier's reconstructive techniques were used. Perioperative mortality was 2.5% (1 patient). Reoperation was necessary in 1 patient. Late mortality was 2.5% (1 patient). Repair was assessed either by angiography or by Doppler echocardiography before hospital discharge: 32 patients showed no regurgitation, whereas 7 had mild regurgitation (3 aortic, 4 mitral). Mean follow-up of 30 months was achieved in all survivors. There was no recurrence of endocarditis and no reoperation for valvular insufficiency. We conclude that valve repair in acute endocarditis is possible and effective in most instances.

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				O. A. Araji, J. M. Barquero, M. Almendro, M. A. Gutierrez, M. Garcia-Borbolla, C. J. Velazquez, and C. A. Infantes Replacement of A2 and a3 by pericardium due to endocarditis of the anterior leaflet of the mitral valve. Ann. Thorac. Surg., February 1, 2009; 87(2): 653 - 654. [Abstract] [Full Text] [PDF]

				S. C. Stamou, G. Petterson, and A. M. Gillinov Surgical Treatment of Mitral Valve Endocarditis Card. Surg. Adult, January 1, 2008; 3(2008): 1069 - 1078. [Full Text]

				R. Gottardi, J. Bialy, E. Devyatko, H. Tschernich, M. Czerny, E. Wolner, and R. Seitelberger Midterm Follow-Up of Tricuspid Valve Reconstruction Due to Active Infective Endocarditis Ann. Thorac. Surg., December 1, 2007; 84(6): 1943 - 1948. [Abstract] [Full Text] [PDF]

				E. M. Delmo Walter, M. Musci, N. Nagdyman, M. Hubler, F. Berger, and R. Hetzer Mitral Valve Repair for Infective Endocarditis in Children Ann. Thorac. Surg., December 1, 2007; 84(6): 2059 - 2065. [Abstract] [Full Text] [PDF]

				P. Fundaro, P. M Tartara, E. Villa, P. Fratto, S. Campisi, and E. O Vitali Mitral Valve Repair: Is There Still a Place for Suture Annuloplasty? Asian Cardiovasc Thorac Ann, August 1, 2007; 15(4): 351 - 358. [Abstract] [Full Text] [PDF]

				H. Morimoto, K. Tsuchiya, M. Nakajima, O. Akashi, and K. Kato Mitral Valve Repair for Extended Commissural Prolapse Involving Complex Prolapse Asian Cardiovasc Thorac Ann, June 1, 2007; 15(3): 210 - 213. [Abstract] [Full Text] [PDF]

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				H. H.H. Feringa, J. J. Bax, P. Klein, R. J.M. Klautz, J. Braun, Ernst. E. van der Wall, D. Poldermans, and R. A.E. Dion Outcome after mitral valve repair for acute and healed infective endocarditis Eur. J. Cardiothorac. Surg., March 1, 2006; 29(3): 367 - 373. [Abstract] [Full Text] [PDF]

				G Doukas, M Oc, C Alexiou, A W Sosnowski, N J Samani, and T J Spyt Mitral valve repair for active culture positive infective endocarditis Heart, March 1, 2006; 92(3): 361 - 363. [Abstract] [Full Text] [PDF]

				S A Livesey Mitral valve reconstruction in the presence of infection Heart, March 1, 2006; 92(3): 289 - 290. [Abstract] [Full Text] [PDF]

				J. S. Gammie, S. M. O'Brien, B. P. Griffith, and E. D. Peterson Surgical Treatment of Mitral Valve Endocarditis in North America Ann. Thorac. Surg., December 1, 2005; 80(6): 2199 - 2204. [Abstract] [Full Text] [PDF]

				S. Aubert, T. Barreda, C. Acar, P. Leprince, N. Bonnet, R. Ecochard, A. Pavie, and I. Gandjbakhch Mitral valve repair for commissural prolapse: surgical techniques and long term results Eur. J. Cardiothorac. Surg., September 1, 2005; 28(3): 443 - 447. [Abstract] [Full Text] [PDF]

				E. Ruttmann, C. Legit, G. Poelzl, S. Mueller, O. Chevtchik, M. Cottogni, H. Ulmer, O. Pachinger, G. Laufer, and L. C. Mueller Mitral valve repair provides improved outcome over replacement in active infective endocarditis J. Thorac. Cardiovasc. Surg., September 1, 2005; 130(3): 765 - 771. [Abstract] [Full Text] [PDF]

				R. Zegdi, M. Debieche, C. Latremouille, D. Lebied, C. Chardigny, J.-M. Grinda, S. Chauvaud, A. Deloche, A. Carpentier, and J.-N. Fabiani Long-Term Results of Mitral Valve Repair in Active Endocarditis Circulation, May 17, 2005; 111(19): 2532 - 2536. [Abstract] [Full Text] [PDF]

				P Tornos, B Iung, G Permanyer-Miralda, G Baron, F Delahaye, C. Gohlke-Barwolf, E G Butchart, P Ravaud, and A Vahanian Infective endocarditis in Europe: lessons from the Euro heart survey Heart, May 1, 2005; 91(5): 571 - 575. [Abstract] [Full Text] [PDF]

				M. H. Yacoub and L. H. Cohn Novel Approaches to Cardiac Valve Repair: From Structure to Function: Part II Circulation, March 9, 2004; 109(9): 1064 - 1072. [Full Text] [PDF]

				M. Nakajima, K. Tsuchiya, H. Inoue, K. Kobayashi, E. Mizutani, and K. Takizawa Leaflet folding plasty combined with annular plication for mitral valve repair Ann. Thorac. Surg., March 1, 2004; 77(3): 1103 - 1104. [Abstract] [Full Text] [PDF]

				B. Iung, J. Rousseau-Paziaud, B. Cormier, E. Garbarz, O. Fondard, E. Brochet, C. Acar, J.-P. Couetil, U. Hvass, and A. Vahanian Contemporary results of mitral valve repair for infective endocarditis J. Am. Coll. Cardiol., February 4, 2004; 43(3): 386 - 392. [Abstract] [Full Text] [PDF]

				A. M. Gillinov and D. M. Cosgrove III Mitral Valve Repair Card. Surg. Adult, January 1, 2003; 2(2003): 933 - 950. [Full Text]

ARTICLES

Valve repair in acute endocarditis

				F. Filsoufi and D. H. Adams Surgical Treatment of Mitral Valve Endocarditis Card. Surg. Adult, January 1, 2003; 2(2003): 987 - 997. [Full Text]

				J.-P. A. Couetil, P. G. Argyriadis, A. Shafy, A. Cohen, A. J. Berrebi, D. F. Loulmet, J.-C. Chachques, and A. F. Carpentier Partial replacement of the tricuspid valve by mitral homografts in acute endocarditis Ann. Thorac. Surg., June 1, 2002; 73(6): 1808 - 1812. [Abstract] [Full Text] [PDF]

				A. M. Gillinov, C. N. Faber, J. F. Sabik, G. Pettersson, B. P. Griffin, S. M. Gordon, E. Hayek, L. M. Di Paola, D. M. Cosgrove III, and E. H. Blackstone Endocarditis after mitral valve repair Ann. Thorac. Surg., June 1, 2002; 73(6): 1813 - 1816. [Abstract] [Full Text] [PDF]

				J. M. Jones and M. A.I. Sarsam Partial mitral valve replacement for acute endocarditis Ann. Thorac. Surg., July 1, 2001; 72(1): 255 - 257. [Abstract] [Full Text] [PDF]

				A. M. Gillinov, R. Diaz, E. H. Blackstone, G. B. Pettersson, J. F. Sabik, B. W. Lytle, and D. M. Cosgrove III Double valve endocarditis Ann. Thorac. Surg., June 1, 2001; 71(6): 1874 - 1879. [Abstract] [Full Text] [PDF]

				D. Delay, M. Pellerin, M. Carrier, R. Marchand, P. Auger, L. P. Perrault, Y. Hebert, R. Cartier, P. Page, and L. C. Pelletier Immediate and long-term results of valve replacement for native and prosthetic valve endocarditis Ann. Thorac. Surg., October 1, 2000; 70(4): 1219 - 1223. [Abstract] [Full Text] [PDF]

				F. J. Baumgartner, B. O. Omari, J. M. Robertson, R. J. Nelson, A. Pandya, A. Pandya, and J. C. Milliken Annular abscesses in surgical endocarditis: anatomic, clinical, and operative features Ann. Thorac. Surg., August 1, 2000; 70(2): 442 - 447. [Abstract] [Full Text] [PDF]

				D. T.M. Lai and R. B. Chard Commissuroplasty: a method of valve repair for mitral and tricuspid endocarditis Ann. Thorac. Surg., November 1, 1999; 68(5): 1727 - 1730. [Abstract] [Full Text] [PDF]

				R. Choussat, D. Thomas, R. Isnard, P.-L. Michel, B. Iung, G. Hanania, P. Mathieu, M. David, T. du Roy de Chaumaray, G. De Gevigney, et al. Perivalvular abscesses associated with endocarditis: Clinical features and prognostic factors of overall survival in a series of 233 cases Eur. Heart J., February 1, 1999; 20(3): 232 - 241. [Abstract] [PDF]

				P. Totaro, E. Tulumello, P. Fellini, M. Rambaldini, G. La Canna, G. Coletti, M. Zogno, and R. Lorusso Mitral valve repair for isolated prolapse of the anterior leaflet: an 11-year follow-up Eur. J. Cardiothorac. Surg., February 1, 1999; 15(2): 119 - 126. [Abstract] [Full Text] [PDF]