Surgical Management of Mitral Valve Endocarditis

Before the antibiotic era and cardiac surgery, infective endocarditis (IE) was a predominantly fatal disease. In-hospital mortality persists relatively high despite development in medical and surgical treatment. Adequate timing and surgical management of the infected valve help prevent substantially early and late mortality. The surgical approach of mitral valve endocarditis should be based on extension of the disease and annular involvement. When the valve and annulus are severely affected, the best option is to perform a complete excision and mitral valve replacement (MVR). Only if the disease is limited to the valvular tissue, mitral valve repair is the preferred surgical option

Surgical treatment of multivalvular endocarditis: Twenty-one–year single center experience

ObjectiveLittle information is available about surgical outcomes in patients with multivalvular endocarditis. The aim of this article is to review the 21-year experience with surgical treatment of patients with multivalvular endocarditis at our institution and, in particular, to determine the incidence, pathologic status, diagnosis, surgical strategies, and outcomes of patients with this disease.MethodsFrom January 1986 to December 2006, a total of 48 patients (40 men, 8 women), with a mean age of 42 ± 12 years, underwent surgery for multivalvular endocarditis. Endocarditis was active in 32 patients and healed in 16. Preoperative transthoracic echocardiographic evaluation was performed in all 48 patients with addition of transesophageal echocardiography in 22 (45.8%). Intraoperative findings showed that the endocarditis involved mostly the mitral and aortic valves (40/48 patients). Triple or quadruple valve involvement was found in 1 and 2 patients, respectively. Preoperative, perioperative, and postoperative data were retrospectively analyzed and risk factors for early and late survival were determined.ResultsIn only 24 (50.0%) patients was multivalvular endocarditis diagnosed by preoperative transthoracic echocardiography; 17 (77.3%) patients had multivalvular endocarditis confirmed by preoperative transesophageal echocardiography. The 30-day hospital mortality was 12.5% (n = 6). Preoperative renal failure, New York Heart Association class IV, and emergency surgery were identified as independent risk factors for hospital mortality. Overall long-term survival was 74% ± 6% at 5 years and 62% ± 3% at 10 years. Multivariate analysis revealed that renal failure and recurrent endocarditis were associated with increased late mortality. Ten-year freedom from recurrent endocarditis was 74% ± 5% and 10-year freedom from reoperation was 73% ± 6%.ConclusionsIn our institution, multivalvular endocarditis was diagnosed by transthoracic echocardiography in only half of the patients. Intraoperative transesophageal echocardiography provided a more effective means to identify this disease. Radical resection of all infected tissues for patients with multivalvular endocarditis and additional intraoperative interventions, depending on the intraoperative pathologic condition, produced satisfactory in-hospital and long-term results, similar to those in patients with a single infected heart valve

Surgery for Tricuspid Valve Endocarditis in the Current Era

Tricuspid valve endocarditis (TVE) continues to be on the rise and has been mostly attributed to the growing epidemic of intravenous drug abuse (IVDA). Other risk factors include long-term indwelling central venous catheters and implantable cardiac devices. While medical management continues to be the first line therapy, surgery is indicated when medical management fails, and in the presence of hemodynamic deterioration, recurrent septic pulmonary embolization and/or persistent sepsis. Tricuspid valve (TV) excision once was the main surgical strategy, but other options include TV repair/reconstruction and replacement. Remaining challenges include management of drug-induced endocarditis and the best strategy for recurrent infection

Surgical solutions for complex aortic root pathology

Patients, from neonates to elderly, in need of aortic root replacement have several surgical options for their problem. This thesis describes the outcomes after aortic root replacement with biological prostheses, focusing on the pulmonary autograft (Ross procedure) and a stentless porcine aortic root prosthesis. These outcomes can be used to inform patients, cardiologists and cardiac surgeons in the shared decision making process of prosthesis choice.LUMC / Geneeskund

Abstracts - SA Heart Congress 2016

Index of abstracts: alphabetical listing of first authors

Mechanical Complications of Myocardial Infarction

Complications of acute myocardial infarction are different and life threatening. Prompt diagnosis and therapy are essential. In this, chapter we will analyse mechanical complications, such as ventricular free wall rupture, ventricular septal defect, papillary muscle rupture, ischaemic mitral regurgitation, left ventricle aneurysm, and cardiogenic shock

New insights in diagnostic and treatment modalities of native aortic and prosthetic graft infections

In this thesis several aspects of the diagnosis and treatment of infectious native aortic aneurysm (INAA) and vascular graft and endograft infection (VGEI) are investigated. Part I is mainly about diagnostics. Part II describes various biological materials used in vascular surgery. Part I contains a study focusing on INAA and another study focusing on the reporting of [18F]FDG PET/CT scans for the diagnosis of VGEI. In addition, a case is described, in which the importance of a systematic approach in the diagnosis of VGEI is emphasized. The second part of this thesis contains a study on the use of Omniflow II in different anatomical locations in both an infectious and non-infectious setting. Furthermore, it contains two studies on the use of different patches (including the bovine pericardial patch) used for carotid endarterectomy