Acute Aortic Endocarditis Research Articles

Reintervention for Acute Aortic Prosthesis Endocarditis: Early and Mid-Term Outcomes

Objective: This study aimed to analyze the outcomes and challenges associated with surgical redo procedures following aortic valve replacement for acute infective endocarditis. While transcatheter aortic valve implantation is growing in terms of its utilization for degenerative bioprostheses failure, valve-in-valve procedures are limited in acute aortic endocarditis. Surgical interventions for aortic prosthesis endocarditis carry a significant risk, with a higher mortality and morbidity, often requiring concomitant complex procedures. Methods: This was a retrospective, monocentric, observational study. We identified 352 patients with infective endocarditis from the institutional database. After applying the inclusion and exclusion criteria, 54 patients who underwent surgical re-operation between 2016 and 2023 were included. Endpoints included early and late mortality, complications, and major adverse cardiac and cerebrovascular events (MACCEs). Results: From the cohort, predominantly male and with an average age of 71.9 ± 12.1 years old (79.6%), the following notable findings were derived: isolated aortic valve replacement was feasible only in 34 patients (63%) while more complex procedures were demanded in the other cases; the overall 30-day mortality rate was 18.5%, post-operative ECMO occurred in 9.3% of cases, and post-operative new stroke in 2.7%; the 5-year overall survival rate was 58.3 ± 18.6%, while freedom from MACCEs was 41.7 ± 19.7%. Another re-intervention was required in three patients during follow-up, with one case attributed to re-endocarditis. Conclusions: Despite advancements in surgical and perioperative care, redo procedures for acute infective endocarditis pose significant risks, as evidenced by the high 30-day mortality rate. However, the 5-year survival suggests a relatively acceptable outcome, underscoring the complexities and challenges inherent in managing this condition surgically.

Management of Acute Aortic Infective Endocarditis in Pregnancy

The reported incidence of infective endocarditis during pregnancy is 0,006% and there are no accepted guidelines. Management is individually based according to gestational age and the status of the mother. A multidisciplinary approach is required. Cardiopulmonary bypass, hypothermia and hyperkalemia may be fatal for the foetus due to vasoconstrictive response of the uteroplacental arteries. Herein, we report a case of successful treatment of acute aortic endocarditis during the second trimester of gestation, with a focus on timing of surgery and technical aspects. Keywords: Pregnancy, valve, endocarditis, cardiopulmonary bypass. Read more →

Survival and Quality of Life After Aortic Root Replacement With Homografts in Acute Endocarditis

Treatment of prosthetic aortic valve endocarditis and native aortic valve endocarditis with abscess formation is associated with high mortality and morbidity. Aortic root replacement with a freestanding aortic homograft is an attractive alternative. We report outcome and quality of life after homograft replacement for infective endocarditis. Sixty-two patients with infective prosthetic valve endocarditis (n = 31) or native valve endocarditis with abscess (n = 31), operated with homograft replacement were included. Thirty-day mortality, severe operative complications (dialysis, stroke, pacemaker implantation, myocardial infarction, and prolonged mechanical ventilation), midterm survival, reoperations, and quality of life were assessed after a mean follow-up of 37 ± 11 months. Nine patients (15%) died within 30 days and 22 patients (35%) had severe perioperative complications. Preoperative and perioperative variables univariately associated with early mortality were higher (Cleveland Clinic risk score [p = 0.014], extracorporeal circulation time [p = 0.003], prolonged inotropic support [p = 0.03], reoperation for bleeding [p = 0.01], and perioperative myocardial infarction [p < 0.001].) Cumulative survival was 82%, 78%, 75%, and 67% at one, three, five, and ten years, respectively. One patient was reoperated due to recurrence of endocarditis nine months after surgery and one after five years due to homograft failure. Quality of life, as assessed by the 36 item short-form health survey scales for physical and mental health, was not significantly different to an age-matched and gender-matched healthy control group. Severe acute aortic endocarditis treated with homograft replacement is still associated with a substantial early complication rate and mortality. Long-term survival and quality of life are satisfactory in patients surviving the immediate postoperative period.

Acute aortic valve endocarditis suspicious of paravalvular abscess, consecutive atrioventricular block III° and suspicious of septic embolism

Der 67-jahrige Patient klagt seit 2 Wochen uber reduzierte Leistungsfahigkeit, Arthralgien und Kopfschmerzen. In den letzten Tagen sind eine progrediente Belastungsdyspnoe, Schwindel, Schuttelfrost und Fieber bis 39,8 °C auffallig. Zusatzlich bestehen unspezifische Oberbauchbeschwerden. Bei der korperlichen Untersuchung ist ein neues Herzgerausch (2/6 Diastolikum und Systolikum) im 2. ICR parasternal rechts auskultierbar. Im EKG und im transosophagealen Echokardiogramm (TEE) finden sich drei auffallige Befunde. Welche sind das? Erlauben diese Befunde eine Diagnose? Wenn ja, welche? Sind Differenzialdiagnosen moglich? Wenn ja, welche?

Stentless Bioprosthetic Aortic Valve Replacement After a Homograft Root Replacement: Toronto SPV Implantation After a Homograft Root

Stentless bioprosthetic valves for the aortic position offer excellent hemodynamic characteristics, making them an attractive choice ahead of other valve prostheses. We present a unique case in which a patient underwent aortic valve replacement with a stentless porcine valve and mitral valve repair for severe aortic and mitral regurgitation 1 year after a homograft root replacement for acute aortic endocarditis. The rationale for our approach is outlined in the context of current surgical trends.

Langzeitresultate der chirurgischen Behandlung der akuten Aortenklappenendokarditis

Late results after surgery for acute infectious aortic endocarditis using allografts are compared with those achieved with bioprostheses or mechanical heart valves. Cryopreserved allografts were used in 74 (22 %) and prosthetic heart valve in 262 out of 336 (78 %) patients presenting acute aortic endocarditis. Prosthetic (p = 0.001) and destructive endocarditis (p = 0.001) were more frequent in patients receiving allografts. Mean follow-up time was 6.6 ± 4 years (range, 3 to 28 years). The 30-daymortality was 19 % for allograft patients and 6 % for those receiving prosthetic heart valves (p = 0.002). Early reoperation, postoperative renal failure and sepsis did not differ between groups. After 20 years, actuarial survival was 60 % for mechanical heart valves, 44 % for bioprosthesis and 38 % for allografts (p = 0.003), reoperation was unnecessary in 52 % of mechanical heart valves and 10 % of bioprostheses and allografts (p = 0.0007). Acute infection at the time of operation (p = 0.0001), redo surgery (p = 0.0006), staphylococci (p = 0.0003), older age (p = 0.004) and mitral valve involvement (p = 0.004) were risk factors for late death, irrespective of preoperative antibiotic treatment and type of prosthesis used. A longer bypass and aortic cross-clamp time predicted early (p = 0.0001) and late survival (p = 0.0001), independently. Destructive aortic endocarditis has a poor long-term outcome irrespective of the use of allografts. Acute infection at the time of surgery predicted early and late death; however, surgery is indicated prior to secondary involvement of the mitral valve. The duration of preoperative antibiotic treatment did not affect outcome. A thorough surgical technique directly influences early and late survival.

Endocardite aortique aiguë à Corynebacterium diphteriae à hémoculture négative

Acute endocarditis with negative blood culture is a challenge requiring close cooperation between several specialists. A 15-year-old boy presented with an acute aortic endocarditis due to Corynebacterium diphtheriae. Blood cultures were negative due to an empiric anti-infective therapy. Valvular replacement with a mechanical prosthesis failed to cure the sepsis, which resolved after a cryopreserved allograft implantation. This case underlines the efficiency of the highly specialized bacteriological centers and the advantages of using a cryopreserved allograft during the septic state.

23.8 Acute aortic endocarditis with annular destruction: Assessment of surgical treatment with cryopreserved valvular homografts

23.8 Acute aortic endocarditis with annular destruction: Assessment of surgical treatment with cryopreserved valvular homografts

Aortic-left ventricular discontinuity and aortic regurgitation from acute endocarditis.

During the past 14 years, eight patients have had surgical intervention for acute aortic endocarditis and aortic-left ventricular discontinuity at our institution. Repair of the defect between the aorta and left ventricle was accomplished in two patients with interrupted horizontal pledgeted sutures placed through the left ventricular and aortic walls and through the ring of a valve prosthesis. In the remaining six patients the repair was done with the interposition of a Dacron patch graft between the left ventricle and the aorta, and then the valve prosthesis was sutured to the graft and to the remaining native aortic annulus. One patient died during the operation, one was lost to follow-up four months after operation, and one died of cerebral hemorrhage two years postoperatively. The remaining five patients have had from three months to four years of follow-up. Closure of large defects between the aorta and left ventricle with a patch graft and then suturing the aortic valve to the patch and to the remaining native aortic annulus allows debridement of all necrotic tissue, placement of the sutures through normal tissue, closure of the defect under no tension, and suturing of the new valve at its normal anatomic level. It also requires no surgical manipulation of the coronary arteries and allows completion of the procedure in the shortest time possible.