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. 2023 May 10:10:1154129.
doi: 10.3389/fcvm.2023.1154129. eCollection 2023.

Aorto-mitral curtain reconstruction in invasive double-valve endocarditis: mid-term outcomes

Martin Vobornik  1 , Salifu Timbilla  1 , Jan Gofus  1 , Petr Smolak  1 , James Lago Chek  1 , Marek Pojar  1 , Eva Cermakova  2 , Pavel Zacek  1 , Jan Vojacek  1
Affiliations

Aorto-mitral curtain reconstruction in invasive double-valve endocarditis: mid-term outcomes

Martin Vobornik et al. Front Cardiovasc Med. .

Abstract

Background: Invasive double-valve endocarditis with structural damage (abscess or perforation) of the aorto-mitral curtain is a relatively rare but fatal diagnosis requiring complex surgical reconstruction. This study presents the short-term and mid-term outcomes from a single center.

Methods: From 2014 to 2021, 20 patients with double-valve endocarditis with structural damage of the aorto-mitral curtain underwent surgical reconstruction (Hemi-Commando procedure n = 16 and Commando procedure n = 4). Data were obtained retrospectively.

Results: In 13 cases, the procedure was a reoperation. The mean cardiopulmonary bypass time was 239 ± 47 min and the mean cross-clamp time was 186 ± 32 min. Concomitant procedures were tricuspid valve repair in two, coronary revascularization in one, closure of a ventricular septal defect in one and hemiarch (using circulatory arrest) in one patient. Eleven patients (55%) required surgical revision for bleeding. Thirty-day mortality was 30% (6 patients)-3 patients from the Hemi-Commando group (19%) and 3 patients from the Commando group (75%). Overall survival at 1, 3 and 5 years was 60%, 50% and 45% respectively. Reoperation was required by 4 patients. Freedom from reoperation at 1, 3 and 5 years was 86%, 71% and 71% respectively.

Conclusion: Despite the high postoperative morbidity and mortality, complex surgical reconstruction of the aorto-mitral continuity of patients with double-valve endocarditis represents the only real chance for survival. Mid-term outcomes are acceptable, but strict follow-up is required due to the risk of valve failure.

Keywords: aorto-mitral continuity; commando procedure; hemi-commando procedure; infective endocarditis; intervalvular fibrosa.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
(A,B) Transesophageal echocardiography showing the perforation of the aorto-mitral curtain (green arrow) in a patient with double-valve endocarditis; LA, left atrium; LV, left ventricle.
Figure 2
Figure 2
Intraoperative photograph (view into the left ventricular outflow tract and the left and right atrium using combined manouguian-guiraudon approach) showing the perforation of the aorto-mitral curtain (green arrow); LA, left atrium; AML, anterior mitral valve leaflet; RCA, right coronary artery; LCA, left coronary artery.
Figure 3
Figure 3
Intraoperative photograph (view into the left ventricular outflow tract and the left and right atrium using combined manouguian-guiraudon approach), showing the status after radical excision of the perforated AMC, stitches in fibrous trigones (green arrows); LA, left atrium; AML, residue of anterior mitral valve leaflet; RCA, right coronary artery; LCA, left coronary artery.
Figure 4
Figure 4
Intraoperative photograph showing aortic homograft with preserved anterior leaflet of the mitral valve (green arrow), stitches in fibrous trigones.
Figure 5
Figure 5
(A,B) Postoperative transesophageal echocardiography showing the suture of the anterior mitral leaflet of the homograft with the free edge of the patient's native anterior leaflet (green arrow) with residual mitral insufficiency. LA, left atrium, LV, left ventricle.
Figure 6
Figure 6
Kaplan-Meier estimate for survival after surgery.
Figure 7
Figure 7
Kaplan-Meier estimate for freedom from reoperation.
See this image and copyright information in PMC

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