Aortic valve endocarditis complicated by proximal false aneurysm

Abstract

Background: Aortic valve endocarditis remains a life-threatening condition, especially in cases of periannular complications. Aorto-ventricular discontinuity associated with proximal false aneurysm represents a severe picture caused by extensive tissue disruption and is usually associated with prosthetic valve infection. Complex surgical repair is required in these cases and continues to be associated with high mortality and morbidity rates.Methods: We retrieved information for 32 patients undergoing operation for infective aortic valve/ prosthetic valve endocarditis complicated by pseudoaneurysm arising from aorto-ventricular discontinuity.Patients were relatively young, mostly male and most of them had a prior cardiac operation. Aortic root replacement with valve graft conduit was performed in all cases; it was associated with other procedures in seven patients: CABG (n=2), MV surgery (n=3), MV surgery + CABG (n=1) and pulmonary valve replacement (n=1). We reported and analysed patient outcomes at early and mid-term follow-up.Results: Pre-discharge mortality was 22% (n=7). The postoperative course was complicated in 24 (75%) cases. Eighteen patients (56%) sustained low cardiac output resulting in multiple organ failure syndrome and death in five cases. One patient (3%) experienced a major neurologic deficit with a permanent cerebral stroke. Acute kidney injury complicated the course in 12 cases (37%), continuous renal replacement therapy was necessary in four patients (12%). Overall survival and freedom from endocarditis and reoperation at 5-year was 59% and 89%, respectively. Conclusions:Patients with complicated aortic valve endocarditis presented generally in a poor preoperative state. Surgical treatment poses a non-negligible risk of postoperative mortality and morbidity but provides an acceptable survival rate and a satisfactory recovery at mid-term.

Surgical treatment of transcatheter aortic valve infective endocarditis

“…However, we do not believe that our results are far different from reality. They seem to be in line with the more robust findings coming from surgery for infected aortic valve prostheses, for which, due to technical and medical challenges, we could expect an in-hospital mortality rate up to 15-20% [64][65][66]. Furthermore, a recent preliminary analysis of the Society of Thoracic Surgeons database reported a similar postoperative in-hospital mortality (29.3%) in patients who underwent TAVI prosthesis retrieval and surgical aortic valve replacement for infective endocarditis (oral presentation at 2020 ACC World Congress of Cardiology [67]).…”

Endocarditis in Patients with Aortic Valve Prosthesis: Comparison between Surgical and Transcatheter Prosthesis

“…The separation between the aorta and left ventricle of more than one-third of the annular circumference defines the presence of aorto-ventricular discontinuity [ 73 ]. This condition is associated with a wide tissue destruction and poor clinical conditions, with patients generally experiencing severe heart failure, uncontrolled sepsis, and mechanical complications, such as chest pain or syncope, due to systolic collapse of the aortic root and/or ascending aorta [ 72 , 73 , 74 ]. A pseudoaneurysm involving the intervalvular fibrosa and both aortic and mitral valves is a further well-defined complication that is characterised by a pulsatile cavity (systolic expansion and diastolic collapse) in the mitral-aortic junction in communication with LVOT.…”

Redo aortic root operations in late prosthetic endocarditis: clinical case series

“…В большинстве случаев при протезном инфекционном эндокардите поражается зона имплантации манжеты протеза с последующим формированием циркулярного абсцесса и парапротезных фистул [7]. Прогноз при консервативном лечении протезного инфекционного эндокардита крайне неблагоприятный.…”

“…Госпитальная летальность без операции составляет 80% [6,9]. При хирургическом лечении позднего ПЭ госпитальная летальность варьирует от 3,9 до 25,0% [2][3][4][5][6][7][8][9].…”

“…Наиболее трудными из них считаются операции, когда абсцесс распространяется на корень аорты, область митрально-аортального контакта и выводной тракт левого желудочка (ЛЖ). В такой ситуации возникает необходимость в выполнении сложных реконструктивных операций на корне аорты, митрально-аортальном контакте и выводном тракте левого желудочка [6][7][8][9][10][11][12].…”