Surgical treatment of aortic valve endocarditis with aortic annular involvement: a 26-years experience

Abstract

Amac: Bu calismada aortik anulusu etkileyen aort kapak endokarditinin cerrahi tedavisine iliskin erken ve gec donem sonuclar bildirildi. Ca­lis­ma­pla­ni:­Aralik 1985 Ocak 2011 tarihleri arasinda toplam 42 ardisik hasta (32 erkek, 10 kadin; ort. yas 39.0±13.3 yil; dagilim 16-67 yil) cerrahi bulgular ve uygulanan cerrahiler acisindan retrospektif olarak incelendi. Hastalarin 25’inde (%59.5) kan kulturunde ureme tespit edildi ve streptokok en cok (n=15, %35.7) tespit edilen mikroorganizma oldu. On dort hastanin (%33.3) tibbi oykusunde gecirilmis kalp ameliyati varken, 13 hastada (%31) protez kapak endokarditi vardi. Ortalama takip suresi 7.9±4.4 (dagilim 0.1-18.2 yil) yil idi. Bul gu lar: Hastalarin tumune toplam 64 cerrahi islem uygulandi. Yirmi alti (%61.9) hasta ile aort kapak replasmani en sik uygulanan islem iken, bunu 15 hasta ile aort kok replasmani ve bir hasta (%2.4) ile periprostetik kacagin primer onarimi takip etti. Dokuz hastaya (%21.4) es zamanli mitral kapak islemi yapildi. Hastane mortalitesi dokuz hastada (%21.4) goruldu. Ameliyat sonrasi yedi hastada (%16.7) dusuk kalp debisi, alti hastada (%14.3) ise kalp bloku gelisti, fakat yalnizca iki hastada kalici kalp pili kullanimi gerekti. Hastalarin hesaplanan bir, bes ve 10 yillik sagkalim oranlari sirasiyla %80.0±6.3, %69.9±7.3 ve %64.9±8.3 idi. So­nuc:­Aortik anulusu etkileyen aort kapak endokarditi cerrahisi yuksek hastane mortalitesine sahip olsa da, yasayan hastalarin uzun donem sagkalimlari tatmin edicidir. Anah tar soz cuk ler: Anulus; aort kapak; endokardit. Background:­In this study, we report early and late results of surgical treatment of aortic valve endocarditis with aortic annular involvement. Methods: Between December 1985 and January 2011, 42 consecutive patients (32 males, 10 females; mean age 39.0±13.3 years; range 16 to 67 years) were retrospectively analyzed in terms of surgical findings and operative procedures. The blood cultures were positive in 25 patients (59.5%) and the most commonly identified microorganism was streptococcus (n=15, 35.7%). Fourteen patients (33.3%) had a medical history of previous cardiac surgery and 13 (31.0%) had prosthetic valve endocarditis. The mean duration of follow-up were 7.9±4.4 years (range 0.1 to 18.2 years). Results:­ All patients underwent a total of 64 surgical procedures. The most commonly performed procedure was aortic valve replacement with 26 patients (61.9%), followed by aortic root replacement in 15 (35.7%) and primary repair of periprosthetic leakage in one patient (2.4%). Nine patients (21.4%) had concomitant procedures for the mitral valve. In-hospital mortality was seen in nine patients (21.4%). Postoperatively seven patients had (16.7%) low cardiac output, six had (14.3%) heart block, however, only two of them required permanent pacemaker. The actuarial survival rates at one, five and 10 years were 80.0±6.3%, 69.9±7.3% and 64.9±8.3%, respectively. Conclusion:­Although surgery for aortic valve endocarditis with annular involvement has high in-hospital mortality rate, long-term survival is satisfactory for surviving patients.