Long-term Outcomes of Surgery for Invasive Valvular Endocarditis Involving the Aortomitral Fibrosa.

Area of Science:

• Cardiovascular Surgery
• Infective Endocarditis Research
• Valvular Heart Disease Treatment

Background:

• Invasive double-valve infective endocarditis (IE) poses significant challenges, particularly when involving the intervalvular fibrosa (IVF).
• Surgical reconstruction of the IVF is a complex procedure with limited data on long-term outcomes.

Purpose of the Study:

• To evaluate and compare the long-term clinical outcomes of two distinct surgical techniques for intervalvular fibrosa reconstruction in patients with invasive double-valve infective endocarditis.
• To identify risk factors associated with mortality and reoperation in this patient cohort.

Main Methods:

• A retrospective analysis of 138 patients undergoing surgical reconstruction of the IVF between 1988 and 2017.
• Patients were divided into two groups: double-valve replacement (Commando procedure, n=86) and aortic valve replacement with mitral valve repair (hemi-Commando procedure, n=52).
• Mean follow-up was 41 ± 5.9 months, with assessment of survival, reoperation rates, and recurrent IE.

Main Results:

• Reoperation was required in 82% of patients, with 34% undergoing emergency surgery.
• Hospital mortality was 24% in the Commando group versus 14% in the hemi-Commando group (P=.12).
• Overall survival at 10 years was 37%, and freedom from reoperation at 8 years was 55%. Risk factors for late mortality included coronary artery disease, native valve IE, and specific bacterial organisms.

Conclusions:

• Surgery for invasive IE involving the IVF, though technically demanding, offers the only chance for cure with achievable clinical outcomes.
• The hemi-Commando procedure, incorporating mitral valve repair, demonstrates improved early outcomes for IE cases specifically invading the IVF and limited to the anterior mitral valve leaflet.