Surgical Options for Aortic Root Replacement in Destructive Endocarditis

Szczechowicz, Marcin; Weymann, Alexander; Mkalaluh, Sabreen; Mashhour, Ahmed; Zhigalov, Konstantin

doi:10.21470/1678-9741-2020-0020

Cited by 7 publications

(5 citation statements)

References 25 publications

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“…The group reported a freedom from reoperation with the Medtronic Freestyle to be 97.2% at a median of 2.7 years postoperatively. In a separate study by Szczechowicz et al [ 50 ], the same group compared long-term outcomes of 80 patients undergoing either root replacement with Medtronic Freestyle, homograft, bioprosthetic, or mechanical valves. Homograft and stentless valves demonstrated the best mean survival rates (13.7 years and 8.1 years) followed by the biological and mechanical stented valves (2.8 and 1.4 years respectively).…”

Section: Resultsmentioning

confidence: 99%

The Surgical Treatment of Infective Endocarditis: A Comprehensive Review

Arjomandi Rad,

Zubarevich,

Osswald

et al. 2024

Diagnostics

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Infective endocarditis (IE) is a severe cardiac complication with high mortality rates, especially when surgical intervention is delayed or absent. This review addresses the expanding role of surgery in managing IE, focusing on the variation in surgical treatment rates, the impact of patient demographics, and the effectiveness of different surgical approaches. Despite varying global data, a notable increase in surgical interventions for IE is evident, with over 50% of patients undergoing surgery in tertiary centres. This review synthesizes information from focused literature searches up to July 2023, covering preoperative to postoperative considerations and surgical strategies for IE. Key preoperative concerns include accurate diagnosis, appropriate antimicrobial treatment, and the timing of surgery, which is particularly crucial for patients with heart failure or at risk of embolism. Surgical approaches vary based on valve involvement, with mitral valve repair showing promising outcomes compared to replacement. Aortic valve surgery, traditionally favouring replacement, now includes repair as a viable option. Emerging techniques such as sutureless valves and aortic homografts are explored, highlighting their potential advantages in specific IE cases. The review also delves into high-risk groups like intravenous drug users and the elderly, emphasizing the need for tailored surgical strategies. With an increasing number of patients presenting with prosthetic valve endocarditis and device-related IE, the review underscores the importance of comprehensive management strategies encompassing surgical and medical interventions. Overall, this review provides a comprehensive overview of current evidence in the surgical management of IE, highlighting the necessity of a multidisciplinary approach and ongoing research to optimize patient outcomes.

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Section: Resultsmentioning

confidence: 99%

The Surgical Treatment of Infective Endocarditis: A Comprehensive Review

Arjomandi Rad,

Zubarevich,

Osswald

et al. 2024

Diagnostics

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“…Due to its flexibility, it offers perfect hemostatic qualities and excellent hemodynamic performance. Moreover, it also offers better outcomes in patients with destructive IE as valvular conduits 7 . The conduit is attached to the anterior part of the mitral valve prosthesis and to the rest of the native aortic annulus.…”

Section: Methodsmentioning

confidence: 99%

Essen—Commando: How we do it

et al. 2020

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In rare cases of extensive aortic root or mitral valve infective endocarditis (IE), severe calcification of the aortic and mitral valves, or double-valve procedures in patients with small aortic and mitral annuli, surgical reconstruction of the intervalvular fibrous body (IVFB) is required. A high mortality is generally associated with this procedure, and it is frequently avoided by surgeons due to a lack of experience. It is crucial to radically resect all tissues that are severely affected by IE to prevent recurrence in the patient. Our experience with the Commando procedure in patients with extensive double-valve IE involving the IVFB is presented in this article.

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“…Navíc z naší zkušenosti a zkušeností některých center poskytují lepší hemostatické vlastnosti, a tím výrazně snižují riziko pooperačního krvácení. 13,14 Jako alternativa se u mladých pacientů nabízí Rossova operace, 15 doposud ale v této indikaci není široce využívána. Je spíše specialitou některých center, které mají s touto technikou zkušenosti, a použitelná u pacientů bez extenzivního postižení aortálního kořene.…”

Section: Diskuseunclassified

“…Při konkomitantním postižení ascendentní aorty se nabízí využití biologického nebo mechanického konduitu . 14 V specifi ckých případech u pacientů po několika reoperacích s perzistentní IE je radikálním řešením pouze transplantace srdce. 2 Samotná operace Commando byla popsána v několika modifi kacích.…”

Section: Diskuseunclassified

(Aortomitral continuity reconstruction in double-valve infective endocarditis)

Kolárik¹,

Fila²,

Ondrášek³

et al. 2021

Cor Vasa

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Kazuistika prezentuje případ 53letého pacienta po mitrální plastice s několik měsíců trvajícími nespecifi ckými obtížemi charakteru zvýšené teploty, úbytku hmotnosti a bolestmi zad. Po ischemické cévní mozkové příhodě bylo provedeno echokardiografi cké vyšetření, které odhalilo vyprázdněný perianulární absces aortální chlopně. Při dalším sledování došlo k progresi nemoci s postižením aortomitrální kontinuity. Tato forma onemocnění patří mezi vzácné manifestace infekční endokarditidy. Pacient podstoupil chirurgický výkon na našem pracovišti za užití modifi kované procedury Commando. Byl implantován aortální homograft se zachovaným předním cípem mitrální chlopně, což umožnilo kompletní resekci postižené tkáně a implantaci mitrální bioprotézy. Při postižení centrálního fi brózního tělesa jsou aortální homografty vhodnou formou náhrady aortální chlopně bez použití umělého materiálu.

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Surgical Options for Aortic Root Replacement in Destructive Endocarditis

Cited by 7 publications

References 25 publications

The Surgical Treatment of Infective Endocarditis: A Comprehensive Review

The Surgical Treatment of Infective Endocarditis: A Comprehensive Review

Essen—Commando: How we do it

(Aortomitral continuity reconstruction in double-valve infective endocarditis)

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