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DOI: 10.1055/s-0035-1544465
Redo-surgery in Prosthetic Aortic Valve Endocarditis - A Surgical Challenge
Objectives: Surgery for prosthetic aortic valve endocarditis (aPVE) is technically challenging and carries high risk. In this retrospective study we aim to analyze operative outcome of redo-surgery on aPVE and to determine risk factors particularly with regard to clinical condition and operative findings.
Methods: All patients with redo-surgery for aPVE between 01/2007 and 06/2014 were included. We identified 81 patients (26 female; mean age 68 ± 12 years). 76% were in NYHA-class III/IV at admission. 55 patients received single prosthetic valve replacement; in 22 patients, either the mitral valve (n = 18) or tricuspid valve (n = 4) were additionally addressed; 4 patients had aortic valve re-replacement with concomitant mitral and tricuspid valve surgery as triple valve operation.
Results: Mean cross-clamp time was 86 ± 39 minute. In 49 (60%) patients aPVE was associated with abscess formation necessitating extended surgery. 16 (20%) patients had intraaortic balloon pump, 7 (9%) were on ECMO. All patients had administration of catecholamines. Mean ventilation time was 1 ± 4 days; 4 patients had tracheostomy for weaning from ventilaton. Operative complications were re-thoracotomy for bleeding in 14 (17%), sternal wound infection in 3 (4%) and necessity for pacemaker implantation in 14 (17%). One patient required early intracardiac re-operation. Hospital mortality was 42% (34 patients) and was associated with ECMO (p = 0.001), higher NYHA-class (p < 0.001), aortic cross-clamp time (p = 0.007) and prolonged ventilation time (p < 0.001), but not with abscess formation (p = 0.516).
Conclusions: aPVE carries high operative mortality particularly in deteriorated preoperative condition. Effective prophylaxis of prosthetic endocarditis is important although recent guidelines are more liberal with regard to antibiotic medications.