Evaluación de los resultados de la cirugía reconstructiva del esqueleto mitroaórtico en la endocarditis infecciosa activa

Abstract

IntroductionSurgical intervention of active infective endocarditis with multiple abscesses and destruction of the intervalvular fibrous body represents a technically demanding procedure with a difficult postoperative management. The experience is presented with an original technique for radical resection and subsequent reconstruction using bovine pericardium. Material and methodsDuring the last eight years in our centre 29 patients with active infective endocarditis and paravalvular abscesses that destroyed the microaortic union underwent surgery (20 over prosthesis and 9 over native valve): 13 of them reached the operating room with severe sepsis. Average EuroScore I of the series was 36±22.7%. Treatment consisted of a broad resection of infected tissue and subsequent reconstruction of the fibrous body with glutaraldehyde fixed bovine pericardium, by means of an original technique. ResultsHospital mortality of the series was 20.7%. Average follow-up was 34.2±28 months, with a maximum of 8 years. Two patients required a reoperation due to periprosthetic aortic valve leaks. Only one relapse of the infectious process was registered. Two patients passed away during follow-up after discharge, for non-cardiac reasons. ConclusionBroad resection of the mitroaortic union and subsequent reconstruction with bovine pericardium can in some cases be the only surgical option to save a patient's life. The authors consider that the presented technique is a repeatable procedure, with acceptable morbidity and mortality, that would minimise the risk of future recurrence.