1
|
Easo J, Szczechowicz M, Hölzl P, Meyer A, Zhigalov K, Malik R, Thomas RP, Weymann A, Dapunt OE. Stentless Root Replacement versus Tissue Valves in Infective Endocarditis - A Propensity-Score Matched Study. Braz J Cardiovasc Surg 2020; 35:411-419. [PMID: 32864918 PMCID: PMC7454622 DOI: 10.21470/1678-9741-2020-0267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction People with aortic/prosthetic valve endocarditis are a high-risk cohort of patients who present a challenge for all medically involved disciplines and who can be treated by various surgical techniques. Methods We analyzed the results of treatment of root endocarditis with Medtronic Freestyle® in full-root technique over 19 years (1999-2018) and compared them against treatment with other tissue valves. Comparison was made with propensity score matching, using the nearest neighbor method. Various tests were performed as suited for adequate analyses. Results Fifty-four patients in the Medtronic Freestyle group (FS group) were matched against 54 complex root endocarditis patients treated with other tissue valves (Tissue group). Hospital mortality was 9/54 (16.7%) in the FS group vs. 14/54 (25.6%) in the Tissue group (P=0.24). Cox regression performed for early results demonstrated coronary heart disease (P=0.004, odds ratio 2.3), among others, influencing early mortality. Recurrent infection was low (1.8% for FS and Tissue patients) and freedom from reoperation was 97.2% at a total of 367 patient-years of follow-up (median of 2.7 years). Conclusion The stentless xenograft is a viable alternative for treatment of valve/root/prosthetic endocarditis, demonstrating a low rate of reinfection. The design of the bioroot allows for complex reconstructive procedures at the outflow tract and the annular level with at an acceptable operative risk. Endocarditis patients can be treated excluding infective tissue from the bloodstream, possibly with benefits, concerning bacteremia and recurrent infection. Furthermore, the use of the stentless bioroot offers varying treatment options in case of future valve degeneration.
Collapse
Affiliation(s)
- Jerry Easo
- Department of Cardiac Surgery, University Clinic Oldenburg, European Medical School Oldenburg-Groningen, Oldenburg, Germany
| | - Marcin Szczechowicz
- Department of Cardiac Surgery, University Clinic Oldenburg, European Medical School Oldenburg-Groningen, Oldenburg, Germany
| | - Philipp Hölzl
- Division of Cardiac Surgery, Medical University of Graz, Graz, Austria
| | - Adrian Meyer
- Department of Thoracic and Cardiovascular Surgery, Essen University Hospital, Essen Germany
| | - Konstantin Zhigalov
- Department of Thoracic and Cardiovascular Surgery, Essen University Hospital, Essen Germany
| | - Rizwan Malik
- Department of Thoracic and Cardiovascular Surgery, Essen University Hospital, Essen Germany
| | - Rohit Philip Thomas
- Department of Diagnostic and Interventional Radiology, Philipps-University Marburg, Marburg, Germany
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, Essen University Hospital, Essen Germany
| | - Otto E Dapunt
- Division of Cardiac Surgery, Medical University of Graz, Graz, Austria
| |
Collapse
|
2
|
Easo J, Szczechowicz M, Hoelzl P, Horst M, Eichstaedt H, Zhigalov K, Mashhour A, Weymann A, Dapunt OE. Use of the Medtronic Freestyle for aortic valve infection: A retrospective propensity score matched analysis. J Card Surg 2019; 34:957-964. [PMID: 31376235 DOI: 10.1111/jocs.14176] [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: 12/17/2022]
Abstract
BACKGROUNDS Aortic valve and prosthetic valve endocarditis present a challenging subgroup of patients at high risk. We analyzed our experience using the Medtronic Freestyle in full root technique for the treatment of these cases over 18-year time period. METHODS We investigated the endocarditis subgroup from our cohort of 971 patients and compared results against other valve types with propensity score matching implementing nearest neighbor method. T-test, χ2 test, logistic regression, and Cox regression were performed. RESULTS Fifty-four patients from the Freestyle group (FS) were matched against 54 patients from a cohort of 376 aortic valve/root endocarditis patients treated by other valve types (non-FS). Hospital mortality was 9/54 (16.7%) in the FS vs 13/54 (24.1%) in the non-FS group (P = .33). Variables age (P = .003) and renal impairment (P = .026) had an impact on mortality according to Cox regression analysis for early results. Variables with significant risk for long-term mortality included postoperative renal impairment (P = .0001) and multiorgan failure (P = .0001). Recurrent infection was low (1.8% for FS and 3.7% for non-FS group), and freedom from reoperation was 97.2%. Use of the Medtronic Freestyle was no significant risk factor for long-term mortality. CONCLUSION The Freestyle stentless xenograft is a viable alternative for treatment of valve/root and prosthetic endocarditis. In our experience, it showed good postoperative performance with low rate of reinfection while having an acceptable operative risk-profile for this high-risk cohort.
Collapse
Affiliation(s)
- Jerry Easo
- Department of Cardiac Surgery, European Medical School Oldenburg-Groningen, University Clinic Oldenburg, Oldenburg, Germany
| | - Marcin Szczechowicz
- Department of Cardiac Surgery, European Medical School Oldenburg-Groningen, University Clinic Oldenburg, Oldenburg, Germany
| | - Philipp Hoelzl
- Department of Cardiac and Thoracic Surgery, HELIOS Hospital Siegburg, Siegburg, Germany
| | - Michael Horst
- Department of Cardiac Surgery, European Medical School Oldenburg-Groningen, University Clinic Oldenburg, Oldenburg, Germany
| | - Harald Eichstaedt
- Department of Cardiac Surgery, European Medical School Oldenburg-Groningen, University Clinic Oldenburg, Oldenburg, Germany
| | - Konstantin Zhigalov
- Department of Cardiac Surgery, European Medical School Oldenburg-Groningen, University Clinic Oldenburg, Oldenburg, Germany
| | - Ahmed Mashhour
- Department of Cardiac Surgery, European Medical School Oldenburg-Groningen, University Clinic Oldenburg, Oldenburg, Germany
| | - Alexander Weymann
- Department of Cardiac Surgery, European Medical School Oldenburg-Groningen, University Clinic Oldenburg, Oldenburg, Germany
| | - Otto E Dapunt
- Division of Cardiac Surgery, Medical University of Graz, Graz, Austria
| |
Collapse
|
3
|
Gomes A, Jainandunsing JS, van Assen S, van Geel PP, Sinha B, Gelsomino S, Johnson DM, Natour E. A standardized approach to treat complex aortic valve endocarditis: a case series. J Cardiothorac Surg 2018; 13:32. [PMID: 29673380 PMCID: PMC5909265 DOI: 10.1186/s13019-018-0715-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 04/04/2018] [Indexed: 11/21/2022] Open
Abstract
Background Surgical treatment of complicated aortic valve endocarditis often is challenging, even for experienced surgeons. We aim at demonstrating a standardized surgical approach by stentless bioprostheses for the treatment of aortic valve endocarditis complicated by paravalvular abscess formation. Methods Sixteen patients presenting with aortic valve endocarditis (4 native and 12 prosthetic valves) and paravalvular abscess formation at various localizations and to different extents were treated by a standardized approach using stentless bioprostheses. The procedure consisted of thorough debridement, root replacement with reimplantation of the coronary arteries and correction of accompanying pathologies (aortoventricular and aortomitral dehiscence, septum derangements, Gerbode defect, total atrioventricular conduction block, mitral and tricuspid valve involvement). Results All highly complex patients included (14 males and 2 females; median age 63 years [range 31–77]) could be successfully treated with stentless bioprostheses as aortic root replacement. Radical surgical debridement of infected tissue with anatomical recontruction was feasible. Although predicted operative mortality was high (median logarithmic EuroSCORE I of 40.7 [range 12.8–68.3]), in-hospital and 30-day mortality rates were favorable (18.8 and 12.5% respectively). Conclusions Repair of active aortic valve endocarditis complicated by paravalvular abscess formation and destruction of the left ventricular outflow tract with stentless bioprosthesis is a valuable option for both native and prosthetic valves. It presents a standardized approach with a high success rate for complete debridement, is readily available, and yields comparable clinical outcomes to the historical gold standard, repair by homografts. Additionally, use of one type of prosthesis reduces logistical issues and purchasing costs.
Collapse
Affiliation(s)
- Anna Gomes
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
| | - Jayant S Jainandunsing
- Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Sander van Assen
- Department of Internal Medicine, Infectious Diseases, Treant Care Group, Hoogeveen, Netherlands
| | - Peter Paul van Geel
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Bhanu Sinha
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Sandro Gelsomino
- Department of Thoracic Surgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - Daniel M Johnson
- Department of Thoracic Surgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - Ehsan Natour
- Department of Thoracic Surgery, Maastricht University Medical Center, Maastricht, Netherlands.,Department of Cardio-Thoracic Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| |
Collapse
|
4
|
Sponga S, Daffarra C, Pavoni D, Vendramin I, Mazzaro E, Piani D, Nalli C, Nucifora G, Livi U. Surgical management of destructive aortic endocarditis: left ventricular outflow reconstruction with the Sorin Pericarbon Freedom stentless bioprosthesis†. Eur J Cardiothorac Surg 2015; 49:242-8. [PMID: 25732971 DOI: 10.1093/ejcts/ezv068] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Accepted: 01/02/2015] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The treatment of complicated aortic endocarditis with periannular abscesses and root disarrangement is a surgical challenge, and includes left ventricular outflow tract (LVOT) reconstruction with the patch technique or homograft implantation. The results of a simplified technique to reconstruct the LVOT in destructive endocarditis of either the aortic native valve or valve prosthesis with the Sorin Pericarbon Freedom stentless valve are reported. METHODS Since August 2007, 40 patients with destructive endocarditis (mean age: 69 ± 12, 75% males, European System for Cardiac Operative Risk Evaluation II (EuroSCORE II): 19 ± 13, New York Heart Association (NYHA) class: ≥3 in all cases) have undergone LVOT reconstruction with a Sorin Pericarbon Freedom stentless bioprosthesis. Seven patients (17.5%) were in septic or cardiogenic shock preoperatively, and 18 patients (45%) suffered from moderate or severe aortic regurgitation. Eleven patients (27.5%) experienced preoperative systemic embolizations. Thirty-six cases (90%) were valve redos and 9 patients (22.5%) had concomitant procedures. The mean follow-up was 26 ± 25 months. RESULTS One patient (2.5%) died early (<30 days) and another 3 patients never discharged died due to multiorgan failure and septic shock. Actuarial survival rate was 85 ± 6% at 1 year, and 76 ± 8% at 3 and 5 years, respectively. Twelve patients (30%) required pacemaker implantation because of atrioventricular block and 20 patients (50%) developed or showed a progression of renal failure. One patient (2.5%) had an endocarditis relapse, and 1 (2.5%) showed a mild paraprosthetic aortic leak. No patient needed reoperation. At the last echocardiographic evaluation, mean gradient, peak gradient and left ventricular ejection fraction were 7.9 ± 5.0 mmHg, 15.1 ± 7.2 mmHg and 63.3 ± 9.3%, respectively. CONCLUSIONS The Sorin Pericarbon Freedom stentless prosthesis, with the modified technique herein described, seems to be a good option in most of cases of destructive aortic valve endocarditis. It is promptly available in different sizes, easy to implant and, due to its pericardial inflow skirt, ideal for extensive reconstruction of the LVOT with good haemodynamic performance and low risk of relapse.
Collapse
Affiliation(s)
- Sandro Sponga
- Cardiothoracic Department, University Hospital of Udine, Udine, Italy
| | - Cristian Daffarra
- Cardiothoracic Department, University Hospital of Udine, Udine, Italy
| | - Daisy Pavoni
- Cardiothoracic Department, University Hospital of Udine, Udine, Italy
| | - Igor Vendramin
- Cardiothoracic Department, University Hospital of Udine, Udine, Italy
| | - Enzo Mazzaro
- Cardiothoracic Department, University Hospital of Udine, Udine, Italy
| | - Daniela Piani
- Cardiothoracic Department, University Hospital of Udine, Udine, Italy
| | - Chiara Nalli
- Cardiothoracic Department, University Hospital of Udine, Udine, Italy
| | - Gaetano Nucifora
- Cardiothoracic Department, University Hospital of Udine, Udine, Italy
| | - Ugolino Livi
- Cardiothoracic Department, University Hospital of Udine, Udine, Italy
| |
Collapse
|