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Chiocchi M, Pugliese L, D'Errico F, Di Tosto F, Cerimele C, Pasqualetto M, De Stasio V, Presicce M, Spiritigliozzi L, Di Donna C, Benelli L, Sbordone FP, Grimaldi F, Cammalleri V, De Vico P, Muscoli S, Romeo A, Vanni G, Romeo F, Floris R, Garaci FG, Di Luozzo M. Transcatheter aortic valve implantation in patients with unruptured aortic root pseudoaneurysm: an observational study. J Cardiovasc Med (Hagerstown) 2021; 23:185-190. [PMID: 34506346 DOI: 10.2459/jcm.0000000000001253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Unruptured aortic root pseudoaneurysm (UARP) is a rare complication of aortic valve endocarditis. Infectious spread to the valvular annulus or myocardium can cause septic complications that manifest as wall thickening, and spontaneous abscess drainage leads to pseudoaneurysm formation. We report the first patient series in which transcatheter aortic valve implantation (TAVI) using a single valve-resolved aortic valvulopathy associated with UARP was performed. METHODS At our center, from December 2017 to October 2019, 138 patients underwent TAVI for aortic valve stenosis and/or regurgitation, 20 of whom (12 female patients, 8 male patients) had associated incidental UARP and were considered as our study population. The average age of these patients was 76.9 ± 5.2 years. All patients were assessed using preprocedural and postprocedural multimodality imaging, including transthoracic echocardiography, transesophageal echocardiography, and cardiac computed tomography angiography (CCTA). RESULTS In all cases, the final angiographic examination showed correct valve positioning with complete coverage of the false aneurysm. Post-TAVI CCTA showed presence of total or subtotal UARP thrombosis. The mean follow-up period was 17.5 months (12-23 months). During follow-up, imaging showed normal prosthetic valve function, no significant leakage (trace or mild), and complete UARP exclusion in all patients, without any complications. CONCLUSION In conclusion, percutaneous valve positioning can simultaneously solve pseudoaneurysm complications by excluding the sac and promoting thrombosis.
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Affiliation(s)
- Marcello Chiocchi
- Radiology Division, Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy Cardiology Division, University Department of Medical Sciences Department of Emergency and Acceptance, Unit of Anesthesia, Policlinico Tor Vergata Unit of Cardiology, Ospedale Santo Spirito in Sassia, ASL RM Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
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Ioannou P, Savva E, Kofteridis DP. Infective endocarditis in patients with liver cirrhosis: a systematic review. J Chemother 2021; 33:443-451. [PMID: 33512305 DOI: 10.1080/1120009x.2021.1878332] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Liver cirrhosis is an increasing cause of mortality and morbidity in developed countries. Infective Endocarditis (IE) is an uncommon disease with notable morbidity and mortality. Even though cirrhosis is associated with immune dysfunction and increased occurrence of bacterial infection, IE is infrequently diagnosed in these patients. Thus, the purpose of this study was to systematically review all published cases of IE in patients with cirrhosis in the literature. A systematic review of PubMed, Scopus and Cochrane (through 23th April 2020) for studies providing epidemiological, clinical, microbiological as well as treatment data and outcomes of IE in patients with cirrhosis was performed. A total of 78 studies, containing data of 602 patients, were included. A prosthetic valve was present in 17.8%, while the most common causative pathogen was S. aureus in 26% followed by Streptococcus spp in 16.8%. Aortic valve was the most commonly infected site, followed by mitral valve. Diagnosis was set with a transthoracic ultrasound in 55.2%, while the diagnosis was set at autopsy in 16.7%. Fever and heart failure were the most common clinical presentations. Aminoglycosides, vancomycin, and cephalosporins were the antimicrobials most frequently used for treatment. Clinical cure was noted in 68.2%, while overall mortality was 41.4%. This systematic review thoroughly describes IE in patients with liver cirrhosis and provides information on epidemiology, clinical presentation, treatment and outcomes.
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Affiliation(s)
- Petros Ioannou
- Department of Internal Medicine & Infectious Diseases, University Hospital of Heraklion, Heraklion, Greece
| | - Eirini Savva
- Department of Internal Medicine & Infectious Diseases, University Hospital of Heraklion, Heraklion, Greece
| | - Diamantis P Kofteridis
- Department of Internal Medicine & Infectious Diseases, University Hospital of Heraklion, Heraklion, Greece
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Malvindi PG, Mikus E, Caprili L, Santarpino G, Margari V, Calvi S, Nasso G, Gregorini R, Carbone C, Albertini A, Speziale G, Paparella D. Aortic valve endocarditis complicated by proximal false aneurysm. Ann Cardiothorac Surg 2019; 8:667-674. [PMID: 31832357 DOI: 10.21037/acs.2019.05.17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Aortic valve endocarditis remains a life-threatening condition, especially in cases of periannular complications. Aorto-ventricular discontinuity associated with proximal false aneurysm represents a severe picture caused by extensive tissue disruption and is usually associated with prosthetic valve infection. Complex surgical repair is required in these cases and continues to be associated with high mortality and morbidity rates. Methods We retrieved information for 32 patients undergoing operation for infective aortic valve/prosthetic valve endocarditis complicated by pseudoaneurysm arising from aorto-ventricular discontinuity. Patients were relatively young, mostly male and most of them had a prior cardiac operation. Aortic root replacement with valve graft conduit was performed in all cases; it was associated with other procedures in seven patients: CABG (n=2), MV surgery (n=3), MV surgery + CABG (n=1) and pulmonary valve replacement (n=1). We reported and analysed patient outcomes at early and mid-term follow-up. Results Pre-discharge mortality was 22% (n=7). The postoperative course was complicated in 24 (75%) cases. Eighteen patients (56%) sustained low cardiac output resulting in multiple organ failure syndrome and death in five cases. One patient (3%) experienced a major neurologic deficit with a permanent cerebral stroke. Acute kidney injury complicated the course in 12 cases (37%), continuous renal replacement therapy was necessary in four patients (12%). Overall survival and freedom from endocarditis and reoperation at 5-year was 59% and 89%, respectively. Conclusions Patients with complicated aortic valve endocarditis presented generally in a poor preoperative state. Surgical treatment poses a non-negligible risk of postoperative mortality and morbidity but provides an acceptable survival rate and a satisfactory recovery at mid-term.
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Affiliation(s)
| | - Elisa Mikus
- Cardiac Surgery, Maria Cecilia Hospital, Cotignola, Italy
| | - Luca Caprili
- Cardiac Surgery, Salus Hospital, Reggio Emilia, Italy
| | | | - Vito Margari
- Cardiac Surgery, Santa Maria Hospital, Bari, Italy
| | - Simone Calvi
- Cardiac Surgery, Maria Cecilia Hospital, Cotignola, Italy
| | | | | | | | | | | | - Domenico Paparella
- Cardiac Surgery, Santa Maria Hospital, Bari, Italy.,Department of Emergency and Organ Transplant, University of Bari Aldo Moro, Bari, Italy
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Bentall procedure after previous aortic valve or complete root replacement: Usefulness of self-assembled aortic valve conduit. J Thorac Cardiovasc Surg 2018; 156:89-95.e2. [DOI: 10.1016/j.jtcvs.2018.01.105] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 01/04/2018] [Accepted: 01/30/2018] [Indexed: 11/23/2022]
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Surgery for thoracic aortic disease in Japan: evolving strategies toward the growing enemies. Gen Thorac Cardiovasc Surg 2014; 63:185-96. [DOI: 10.1007/s11748-014-0476-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Indexed: 01/15/2023]
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Doi K, Ohira S, Dohi M, Yamamoto T, Okawa K, Yaku H. A Novel Technique of Aortic Root Reconstruction for Extensive Endocarditis: The Pericardial Skirt Technique. Ann Thorac Surg 2014; 98:1121-3. [DOI: 10.1016/j.athoracsur.2014.01.062] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 12/04/2013] [Accepted: 01/06/2014] [Indexed: 10/24/2022]
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Ghavidel AA, Javadikasgari H, Sadeghpour A, Totonchi Z. Modified aortic root replacement technique in destructive ventricular-aortic discontinuity. Ann Thorac Surg 2014; 97:347-9. [PMID: 24384198 DOI: 10.1016/j.athoracsur.2013.06.066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Revised: 04/15/2013] [Accepted: 06/07/2013] [Indexed: 11/17/2022]
Abstract
We describe a simple technique for aortic root replacement in destructive prosthetic aortic valve endocarditis wherein the fragile aortic annulus tissue is not suitable for suture placement. Therefore, we first reconstructed the intervalvular part with a nontreated pericardial patch and then implanted the aortic composite graft on the aortic root through the roof of the left atrium and reconstructed the defect thus made with another pericardial patch. No complication was seen at 6-month follow up.
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Affiliation(s)
- Alireza Alizadeh Ghavidel
- Heart Valve Disease Research Center, Iran University of Medical Science, Tehran, Iran; Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Science, Tehran, Iran.
| | - Hoda Javadikasgari
- Heart Valve Disease Research Center, Iran University of Medical Science, Tehran, Iran; Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Science, Tehran, Iran
| | - Anita Sadeghpour
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Science, Tehran, Iran
| | - Ziae Totonchi
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Science, Tehran, Iran
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Freestyle root replacement for complex destructive aortic valve endocarditis. J Thorac Cardiovasc Surg 2013; 147:1265-70. [PMID: 23849892 DOI: 10.1016/j.jtcvs.2013.05.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 04/14/2013] [Accepted: 05/02/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVES In destructive aortic valve endocarditis with abscess formation in the root, homografts are used more often than xenografts. Because we had reliable perioperative results with Freestyle (Medtronic Inc, Minneapolis, Minn) xenograft root replacement in these complex patients, we analyzed the long-term outcome in this high-risk indication. METHODS Of 126 consecutive patients with aortic valve endocarditis treated by surgery from 1997 to 2012, 32 (25.4%) received a Freestyle aortic root replacement for severe, destructive valve endocarditis and were studied retrospectively with approval of the local ethical committee. Perioperative complications, recurrence of endocarditis, and long-term morbidity and mortality were analyzed. The follow-up period was 3 months to 11.5 years. RESULTS Indication for surgery was native (n = 9) and prosthetic valve endocarditis (n = 23). In 18 patients, concomitant procedures were performed: coronary bypass (n = 9), additional valve surgery (n = 6), and ascending aortic surgery (n = 7). Thirty-day mortality was 19.4% (n = 6). There were no instances of technical failure requiring modification of the surgical strategy or reoperation for anastomotic bleeding. Actuarial survival at 5 and 10 years was 61.9% and 54.2%, respectively. Freedom from death, reoperation for prostheses dysfunction, and recurrence of endocarditis as the composite end point at 5 and 10 years was 56.3% and 53.1%, respectively. CONCLUSIONS The Freestyle root was used successfully with no technical complications in all patients with most severe destructive aortic root endocarditis. In view of this complex patient population, short- and long-term results make this conduit a reliable choice for treatment of this condition.
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Takahashi H, Arif R, Kallenbach K, Tochtermann U, Karck M, Ruhparwar A. Surgical Treatment of Aortic Valve Endocarditis With Left Ventricular-Aortic Discontinuity. Ann Thorac Surg 2013; 96:72-6. [DOI: 10.1016/j.athoracsur.2013.03.060] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Revised: 01/13/2013] [Accepted: 03/28/2013] [Indexed: 10/26/2022]
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Okada K, Okita Y. Surgical treatment for aortic periannular abscess/pseudoaneurysm caused by infective endocarditis. Gen Thorac Cardiovasc Surg 2012; 61:175-81. [DOI: 10.1007/s11748-012-0152-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2012] [Indexed: 01/27/2023]
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Okamoto Y, Minakata K, Yunoki T, Katsu M, Chino SI, Matsumoto M. Treatment of prosthetic valve endocarditis complicated by destruction of the aortic annulus. Gen Thorac Cardiovasc Surg 2011; 59:553-8. [PMID: 21850581 DOI: 10.1007/s11748-011-0792-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Accepted: 01/24/2011] [Indexed: 02/06/2023]
Abstract
PURPOSE It has been reported that surgical treatment for prosthetic valve endocarditis complicated by destruction of the aortic annulus is associated with high mortality and morbidity. The aim of this study was to evaluate the efficacy of our surgical strategy for this situation. METHODS Between October 2003 and April 2009, eight patients (mean age 68.6 years) with prosthetic valve endocarditis complicated by destruction of the aortic annulus were surgically treated at our hospital. We use a relatively simple procedure consisting of a patch plasty of the abscess cavity in addition to complete removal of the infected tissue of the abscess cavity followed by standard aortic valve replacement. All patients had active endocarditis and were in New York Heart Association functional class III or IV. Preoperative echocardiography revealed that four patients had moderate or severe aortic regurgitation, and two had mitral valve endocarditis as well. RESULTS There were no operative deaths (≤30 days). Cardiac complications included paroxysmal atrial fibrillation in three patients and transient atrioventricular block in one. One patient died of multiple organ failure 66 days after the surgery. The overall in-hospital mortality was 12.5%. Patients were followed-up for 6-49 months (mean 31 months). There was no recurrent prosthetic valve endocarditis. One patient required reoperation (mitral annuloplasty and redo aortic valve replacement). There were two late deaths: lung cancer in one and multiple organ failure related to pneumonia after the aforementioned redo operation in the other. CONCLUSION Our simple procedure for complicated prosthetic valve endocarditis yielded excellent early and midterm outcomes.
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Affiliation(s)
- Yuki Okamoto
- Division of Cardiovascular Surgery, Tominaga Hospital, Osaka, Japan
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Inafuku H, Morishima Y, Nagano T, Arakaki K, Yamashiro S, Kuniyoshi Y. A three-decade experience of radical open endvenectomy with pericardial patch graft for correction of Budd-Chiari syndrome. J Vasc Surg 2009; 50:590-3. [PMID: 19700095 DOI: 10.1016/j.jvs.2009.03.040] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2009] [Revised: 03/18/2009] [Accepted: 03/18/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND We previously reported the value of our operative procedure for Budd-Chiari syndrome (BCS) that comprised reconstruction of the occluded or severely stenosed inferior vena cava (IVC) using an autologous pericardium patch and reopening as many occluded hepatic veins as possible. Here, we present the long-term durability and efficacy of the autologous pericardium patch for reconstruction of the IVC in BCS. METHODS We retrospectively analyzed a series of 53 consecutive patients (mean age, 48.4 +/- 12.8 years; range, 24-76 years; 34 men) who underwent surgical treatment for BCS at our institution from 1979 to 2008. Patency of the IVC and hepatic veins was examined by venography at discharge. Patients attended an outpatient clinic every 1 or 2 months for follow-up. The reconstructed IVC was evaluated by enhanced computed tomography every 1 or 2 years. RESULTS Two in-hospital (operative mortality, 3.7%) and 15 late deaths occurred. During a mean follow-up of 7.6 +/- 6.5 years (range, 0.08-24.1 years), the reconstructed IVC became totally obstructed in three patients, of whom two underwent reoperation, and severely stenosed in two patients, who required percutaneous transvenous balloon venoplasty (PTV). The 5- and 10-year patency rates without reoperation or PTV for the reconstructed IVC were 90.5% and 84.3%, respectively. The cumulative 5- and 10-year survival rates were 89.8% and 70.7%, respectively. CONCLUSION The autologous pericardium patch is effective and durable for reconstructing a diseased IVC in BCS.
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Affiliation(s)
- Hitoshi Inafuku
- Department of Cardiovascular Surgery, Thoracic and Cardiovascular Surgery Division, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan.
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