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. 2023 Jun 1;63(6):ezad114.
doi: 10.1093/ejcts/ezad114.

Extensive aortic root endocarditis with extension into the intervalvular fibrous body: an updated report of a mitral valve sparing approach

Anton Tomšič  1 , Meindert Palmen  1 , Mylene Loncq de Jong  2 , Jesper Hjortnaes  1 , Antoine G H Driessen  2 , Jerry Braun  1 , Nina Ajmone Marsan  3 , Robert J M Klautz  1   2
Affiliations

Extensive aortic root endocarditis with extension into the intervalvular fibrous body: an updated report of a mitral valve sparing approach

Anton Tomšič et al. Eur J Cardiothorac Surg. .

Abstract

Objectives: Aortic root abscess can spread to include adjacent cardiac structures, including the central or intervalvular fibrous body and mitral valve. After radical debridement, complex surgical correction is needed. We describe the results of our mitral valve sparing approach.

Methods: Between January 2004 and December 2020, 60 patients underwent operation for infective endocarditis of the aortic root with extension towards the mitral valve at 2 centres in the Netherlands. Early and late clinical and echocardiographic outcomes were studied.

Results: Prosthetic valve endocarditis was present in 42 (70%) patients and emergent or salvage surgery was performed in 8 (13%) patients. After radical debridement of all infected tissue, mitral valve repair was feasible in 48 (80%) patients. Early mortality occurred in 11 (18%) patients while mechanical circulatory support was needed in 8 (13%) patients. At 10 years after surgery, the estimated reintervention-free survival rate was 51.9% (95% confidence interval 37.0-66.8%). Eight patients underwent reintervention; this was more common in patients who underwent aortic valve rather than root replacement and in patients in whom mitral valve repair was performed without ring annuloplasty. For 48 patients who underwent mitral valve repair, the estimated freedom from recurrent mitral regurgitation rate was 64.4% (95% confidence interval 40.1-88.7%) at 10 years after surgery.

Conclusions: Surgical intervention for extensive infective endocarditis of the aortic root is related to reasonable perioperative morbidity and mortality. Optimal surgical technique is crucial to lower the risk of late reintervention. Mitral valve repair is feasible in the majority of patients with satisfactory durability.

Keywords: Aortic root abscess; Endocarditis; Mitral valve repair.

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Figures

Figure 1:
Figure 1:
Surgical technique includes debridement of all infected tissue, resulting in wide open left ventricular inflow and outflow tracts. Reconstruction starts with implantation of an annuloplasty ring (1). Thereafter, a patch is used to reconstruct the anterior leaflet, with the patch being implanted between the free anterior part of the ring and the remaining free edge of the native anterior leaflet (2). A double patch is implanted (3) and the patch is used to reconstruct the roof of the left atrium and the left ventricular outflow tract (4). Lastly, aortic root replacement is performed (5). *Left and **right coronary artery button.
Figure 2:
Figure 2:
Overall reintervention-free survival for the whole cohort.
Figure 3:
Figure 3:
Freedom from recurrent mitral valve regurgitation in 48 patients who underwent valve repair.
None
See this image and copyright information in PMC

Comment in

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