Urgent Aortic-Valve Replacement for Acute Aortic Regurgitation Due to Infective Endocarditis

Wise, Joe R.; Cleland, W. P.; Hallidie-Smith, K A; Bentall, H. H.; Goodwin, J. F.; Oakley, Celia M.

doi:10.1016/s0140-6736(71)92300-2

Cited by 59 publications

(15 citation statements)

References 20 publications

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“…1,5 In 1 report of 10 patients who underwent aortic valve replacement for acute aortic insufficiency, all patients had evidence of AP. 19 Much of the aforementioned data are decades old.…”

Section: Perforation and Mortalitymentioning

confidence: 99%

Valvular Perforation in Left‐sided Native Valve Infective Endocarditis

Bachour¹,

Zmily²,

Kizilbash³

et al. 2009

Clinical Cardiology

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Background: Left-sided native valve infective endocarditis (LNVIE) can result in mitral (MP) and aortic (AP) valve perforation, the prognostic significance of which remains poorly defined. Hypothesis: Valvular perforation is associated with worse outcomes. Methods: Retrospective review of patients with LNVIE during 1998-2005 was performed to examine characteristics and outcome predictors of LNVIE complicated by valve perforation. Patients were stratified as: group A: MP or AP detected by transesophageal echocardiography (TEE) or surgery; group B: no TEE evidence of MP or AP. Results: A total of 123 patients were included (group A = 47, group B = 76). In group A, 35 patients (74.5%) had MP alone, 11 (23.4%) had AP alone, and 1 patient had both. Severe valvular insufficiency was encountered more in group A (85.1% versus 59.2%, p = 0.003), so was hemodialysis (40.4% versus 17.1%, p = 0.004) and indications for valvular surgery (93.6% versus 77.6%, p = 0.02). Group A had a higher rate of in-hospital death (31.9% versus 15.8%, p = 0.04). Among patients who had an indication for valvular surgery, the in-hospital mortality rate for those who underwent valvular surgery was 16.7% in group A, and 7.9% in group B (p = 0.4), compared to those who did not undergo surgery (71.4% versus 33.3%, p = 0.04). Amongst survivors, hospital stay was on average 9.2 d longer in group A (38.9 versus 29.7 d, p = 0.05). Univariate analysis revealed association between lower survival and valvular perforation (odds ratio [OR]: 0.4, 95% confidence interval [CI]: 0.17-0.95), that was lost after adjusting for hemodialysis. Conclusions: Valve perforation complicating LNVIE is associated with hemodialysis, severe valvular insufficiency, and significant morbidity and mortality. Compared to conservative management, early surgical intervention is associated with improved survival.

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“…1,5 In 1 report of 10 patients who underwent aortic valve replacement for acute aortic insufficiency, all patients had evidence of AP. 19 Much of the aforementioned data are decades old.…”

Section: Perforation and Mortalitymentioning

confidence: 99%

Valvular Perforation in Left‐sided Native Valve Infective Endocarditis

Bachour¹,

Zmily²,

Kizilbash³

et al. 2009

Clinical Cardiology

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“…Valve perforation or rupture leading to sudden aortic and less often mitral incompetence, with subsequent intractable cardiac failure, is now the most common cause of death in patients with bacterial endocarditis (Wise et al, 1971). The mortality in recognized and treated cases of bacterial endocarditis is still considerable and in those who develop aortic incompetence may exceed 50% (Cohen and Freedman, 1961;Uwaydah and Weinberg, 1965).…”

Section: Discussionmentioning

confidence: 99%

“…Acute bacterial endocarditis of the aortic and mitral valves may produce cardiac failure that is not amenable to medical management. The sudden development of aortic incompetence is poorly tolerated and carries a particularly high mortality (Wise et al, 1971). Urgent repair or replacement of one or both valves may become necessary and is often life saving.…”

mentioning

confidence: 99%

“…There have been several reports of valve replacement for acute aortic incompetence after bacterial endocarditis (Wallace, Young and Osterhout, 1965;Windsor and Shanahan, 1967;Wise et al, 1971) but few after acute mitral incompetence (Robicsek et al, 1967;Yacoub et al, 1972;English, Honey and Clelland, 1972). Urgent double valve replacement after acute bacterial endocarditis is, however, rare (Windsor and Shanahan, 1967;Kretschmer and Lawrence, 1969;Gonzalez-Lavin, Wise and Ross, 1971).…”

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confidence: 99%

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Double valve replacement after staphylococcal endocarditis

Smith

Ball

1974

Postgraduate Medical Journal

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“…However, perioperative morbidity and mortality are reduced, and the results of operation are better for patients in whom prior successful medical therapy permits stabilization before aortic valve surgery. Nevertheless, in many patients with severe acute aortic regurgitation, emergency aortic valve replacement is necessary for survival, particularly when the acute left ventricular volume overload is caused by infective endocarditis [5][6][7].…”

mentioning

confidence: 99%

Recognition and Treatment of Acute Aortic Regurgitation

O’Rourke

Walsh

1986

J Intensive Care Med

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Address reprint requests to Dr O'Rourke. Acute aortic regurgitation usually results from infective endocarditis, but is also caused by aortic dissection and trauma to the heart. Most of the left ventricular stroke volume is regurgitated back into the left ventricle; thus, the forward stroke volume to the body and the cardiac output may be severely compromised. An acute increase in left ventricular end-diastolic volume results in a marked increase in left ventricular end-diastolic pressure, and the mitral valve usually closes prematurely. Compensatory tachycardia is the rule and helps to shorten diastole; thus, the time available for aortic regurgitation to occur is reduced, and the cardiac output is often maintained.On physical examination, there is tachycardia; the peripheral arterial pulse shows a rapid rise, but the systolic pressure is normal; the diastolic pressure is normal or even reduced; and the pulse pressure is often normal. The electrocardiogram (ECG) may be normal except for sinus tachycardia and often for nonspecific ST-T changes. The chest roentgenogram usually shows signs of pulmonary venous hypertension or even pulmonary edema. Echocardiography may show vegetations on the aortic valve, prolapse of an aortic leaflet into the left ventricle, and premature mitral valve closure. Doppler echocardiography is useful in detecting the presence of aortic regurgitation.In cases of infective endocarditis, the appropriate antibiotic therapy must be given. Aortic regurgitation due to dissection of the aorta is usually an indication for surgery. In patients with severe aortic regurgitation, available medical therapy includes digitalis, diuretics, and vasodilators. When patients respond dramatically to the use of digitalis, diuretics, and arterial dilators, surgical therapy can be delayed until heart failure and infection are controlled and the patient is more stable. If the patient does not respond immediately and dramatically to therapy, then valve replacement should not be delayed, even if the infection is uncontrolled or the patient has had little antibiotic therapy.Acute aortic regurgitation is a potentially lethal disorder that frequently results in severe left ventricular decompensation and secondary right-heart failure; it often is associated with important arrhythmias, particularly atrioventricular or bundle branch due to involvement of the conduction system by the underlying pathologic process [1,2]. Acute aortic regurgitation and its complications are usually responsive to medical or surgical treatment [1-3].However, successful treatment of acute aortic regurgitation depends on the early diagnosis of acute left ventricular volume overload, an understanding of the pathophysiology, and an aggressive therapeutic approach. Early aortic valve replacement is often necessary because most patients with acute severe aortic regurgitation die within one year unless the incompetent aortic valve is replaced surgically [4]. However, perioperative morbidity and mortality are reduced, and the results of operation are...

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Urgent Aortic-Valve Replacement for Acute Aortic Regurgitation Due to Infective Endocarditis

Cited by 59 publications

References 20 publications

Valvular Perforation in Left‐sided Native Valve Infective Endocarditis

Valvular Perforation in Left‐sided Native Valve Infective Endocarditis

Double valve replacement after staphylococcal endocarditis

Recognition and Treatment of Acute Aortic Regurgitation

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