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Arjomandi Rad A, Zubarevich A, Osswald A, Vardanyan R, Magouliotis DE, Ansaripour A, Kourliouros A, Sá MP, Rassaf T, Ruhparwar A, Sardari Nia P, Athanasiou T, Weymann A. The Surgical Treatment of Infective Endocarditis: A Comprehensive Review. Diagnostics (Basel) 2024; 14:464. [PMID: 38472937 DOI: 10.3390/diagnostics14050464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/08/2024] [Accepted: 02/18/2024] [Indexed: 03/14/2024] Open
Abstract
Infective endocarditis (IE) is a severe cardiac complication with high mortality rates, especially when surgical intervention is delayed or absent. This review addresses the expanding role of surgery in managing IE, focusing on the variation in surgical treatment rates, the impact of patient demographics, and the effectiveness of different surgical approaches. Despite varying global data, a notable increase in surgical interventions for IE is evident, with over 50% of patients undergoing surgery in tertiary centres. This review synthesizes information from focused literature searches up to July 2023, covering preoperative to postoperative considerations and surgical strategies for IE. Key preoperative concerns include accurate diagnosis, appropriate antimicrobial treatment, and the timing of surgery, which is particularly crucial for patients with heart failure or at risk of embolism. Surgical approaches vary based on valve involvement, with mitral valve repair showing promising outcomes compared to replacement. Aortic valve surgery, traditionally favouring replacement, now includes repair as a viable option. Emerging techniques such as sutureless valves and aortic homografts are explored, highlighting their potential advantages in specific IE cases. The review also delves into high-risk groups like intravenous drug users and the elderly, emphasizing the need for tailored surgical strategies. With an increasing number of patients presenting with prosthetic valve endocarditis and device-related IE, the review underscores the importance of comprehensive management strategies encompassing surgical and medical interventions. Overall, this review provides a comprehensive overview of current evidence in the surgical management of IE, highlighting the necessity of a multidisciplinary approach and ongoing research to optimize patient outcomes.
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Affiliation(s)
- Arian Arjomandi Rad
- Medical Sciences Division, University of Oxford, Oxford OX3 9DU, UK
- Department of Surgery and Cancer, Imperial College London, London SW7 5NH, UK
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands
| | - Alina Zubarevich
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany
| | - Anja Osswald
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany
| | - Robert Vardanyan
- Department of Surgery and Cancer, Imperial College London, London SW7 5NH, UK
| | | | - Ali Ansaripour
- Department of Cardiothoracic Surgery, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Antonios Kourliouros
- Department of Cardiothoracic Surgery, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Michel Pompeu Sá
- Department of Cardiothoracic Surgery, UPMC Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, PA 15224, USA
| | - Tienush Rassaf
- Department of Cardiology, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, 45138 Essen, Germany
| | - Arjang Ruhparwar
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany
| | - Peyman Sardari Nia
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands
| | - Thanos Athanasiou
- Department of Surgery and Cancer, Imperial College London, London SW7 5NH, UK
| | - Alexander Weymann
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany
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2
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Ehrlich T, Abeln KB, Froede L, Burgard C, Giebels C, Schäfers HJ. Valve-sparing aortic root replacement-for all patients? J Thorac Cardiovasc Surg 2023:S0022-5223(23)00781-X. [PMID: 37696427 DOI: 10.1016/j.jtcvs.2023.08.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/22/2023] [Accepted: 08/26/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Valve-sparing root replacement (VSRR) has been associated with good survival and low rates of valve-related complications (VRCs). Whether these advantages are present irrespective of patient comorbidity or age is unclear. The aim of this study was to analyze survival and frequency of VRCs in relation to patient comorbidity and age. METHODS Between October 1995 and December 2021, 1156 patients with a bicuspid or tricuspid aortic valve were treated by root remodeling. The mean patient age was 53.3 ± 14 years, and 973 (84%) were male. The mean duration of follow-up was 6.7 ± 5.5 years (median, 5.9 years), and follow-up was 95% complete (7746 patient-years). We analyzed the population according to comorbidity and age at surgery. A discriminating cutoff for the effect of age was determined using receiver operating characteristic curve (ROC) analysis. RESULTS Mean survival at 15 years was 74.7 ± 2.5%. Deceased patients were older (mean, 65.3 ± 12 years vs 51.6 ± 14.1 years; P < .001) at the time of surgery and had more comorbidities (coronary artery disease [CAD], 28.4% vs 9.8%; P < .001). The sole significant adjusted predictor was age (P < .001). By ROC analysis (area under the curve, 0.780), the optimal cutoff for age was 61 years. Survival was 87.1 ± 2.8% at 15 years in patients age <61 years, compared to 55.3 ± 4.3% in patients age >61 years (P < .0001). Using competing risk analysis, VRC-free survival at 15 years was 66.8% at 15 years, including 76.7% in patients age <61 years and 52.4% in those age >61 years (P < .0001). CONCLUSIONS VSRR is associated with a low incidence of VRC and excellent durability. Survival is decreased in the presence of comorbidities, mainly CAD, and patient age >61 years. Despite lower survival, freedom from VRC is good.
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Affiliation(s)
- Tristan Ehrlich
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany
| | - Karen B Abeln
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany
| | - Lennart Froede
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany
| | - Christian Burgard
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany
| | - Christian Giebels
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany
| | - Hans-Joachim Schäfers
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany.
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3
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Doenst T, Gaudino MF. Commentary: Hear no evil, see no evil-except with 4-dimensional cardiac computed tomography! J Thorac Cardiovasc Surg 2023; 165:1298-1299. [PMID: 34049706 DOI: 10.1016/j.jtcvs.2021.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 05/05/2021] [Accepted: 05/07/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Torsten Doenst
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, University Hospital, Jena, Germany
| | - Mario F Gaudino
- Department of Cardiothoracic Surgery at New York Presbyterian, Weill Cornell Medical Center, New York, NY.
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4
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Commentary: Structural abnormalities after Freestyle full aortic root replacement: Time to accept the facts. J Thorac Cardiovasc Surg 2023; 165:1301-1302. [PMID: 34275619 DOI: 10.1016/j.jtcvs.2021.06.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 06/20/2021] [Accepted: 06/21/2021] [Indexed: 11/21/2022]
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5
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Lausberg HF, Schäfers HJ. Recent innovations in aortic valve surgery: True progress? TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2023; 31:155-160. [PMID: 37484648 PMCID: PMC10357859 DOI: 10.5606/tgkdc.dergisi.2023.98551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 02/16/2023] [Indexed: 07/25/2023]
Affiliation(s)
- Henning F. Lausberg
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg, Germany
| | - Hans-Joachim Schäfers
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg, Germany
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Christ T, Sündermann SH, Falk V, Grubitzsch H. Reply to Jasinski et al. Eur J Cardiothorac Surg 2021; 61:730-731. [PMID: 34718500 DOI: 10.1093/ejcts/ezab465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 09/14/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Torsten Christ
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Cardiovascular Surgery, Berlin, Germany
| | - Simon Harald Sündermann
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Cardiovascular Surgery, Berlin, Germany.,German Heart Center Berlin, Department of Cardiothoracic and Vascular Surgery, Berlin, Germany.,German Center for Cardiovascular Research, Partner Site, Berlin, Germany
| | - Volkmar Falk
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Cardiovascular Surgery, Berlin, Germany.,German Heart Center Berlin, Department of Cardiothoracic and Vascular Surgery, Berlin, Germany.,German Center for Cardiovascular Research, Partner Site, Berlin, Germany.,Swiss Federal Institute of Technology (ETH) Zurich, Department of Health Science and Technology, Zurich, Switzerland
| | - Herko Grubitzsch
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Cardiovascular Surgery, Berlin, Germany
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Witten JC, Durbak E, Houghtaling PL, Unai S, Roselli EE, Bakaeen FG, Johnston DR, Svensson LG, Jaber W, Blackstone EH, Pettersson GB. Performance and Durability of Cryopreserved Allograft Aortic Valve Replacements. Ann Thorac Surg 2021; 111:1893-1900. [DOI: 10.1016/j.athoracsur.2020.07.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 07/02/2020] [Accepted: 07/20/2020] [Indexed: 10/23/2022]
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8
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Leeten K, Ditkowski B, Jashari R, Mela P, Jones EAV, Heying R. An In Vitro Model to Study Endothelialization of Cardiac Graft Tissues Under Flow. Tissue Eng Part C Methods 2021; 27:233-241. [PMID: 33544046 DOI: 10.1089/ten.tec.2020.0359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Pulmonary valve replacement is performed with excellent resultant hemodynamics in patients that have underlying congenital or acquired heart valve defects. Despite recent advancements in right ventricular outflow tract reconstruction, an increased risk of developing infective endocarditis remains, which has a more common occurrence for conduits of bovine jugular vein (BJV) origin compared with cryopreserved homografts. The reason for this is unclear although it is hypothesized to be associated with an aberrant phenotypic state of cells that reendothelialize the graft tissue postimplantation. The aim of this study was to develop an in vitro model that enables the analysis of endothelial cell (EC) attachment to cardiac graft tissues under flow. In the experiments, EC attachment was optimized on bovine pericardium (BP) patch using human umbilical vein ECs. Different biological coatings, namely gelatin, fibronectin, plasma, or a combination of fibronectin and plasma were tested. After cell adaptation, graft tissues were exposed to laminar flow in a parallel-plate flow chamber. Cell retention to the tissue was analyzed after nuclear staining with YO-PRO-1 and a membranous localization of VE-cadherin. Experiments showed that combined coating with fibronectin and blood plasma together with a two-phased shear pattern resulted in a relevant cell monolayer on BP patch and cryopreserved homograft. For BJV tissue, no adherent cells under both static and shear conditions were initially observed. In conclusion, having established the new flow chamber system we could obtain EC layers on the surface of BP patch and cryopreserved pulmonary homograft tissues. The presented in vitro system can serve as a competent model to study cell phenotypes on cardiac grafts in the close-to-physiologic environment. Moreover, this approach allows broad applications and enables further development by testing more complex conditions.
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Affiliation(s)
- Kirsten Leeten
- Department of Cardiovascular Sciences, KU Leuven Center for Molecular and Vascular Biology, Leuven, Belgium.,Department of Cardiovascular Sciences, KU Leuven Cardiovascular Developmental Biology, Leuven, Belgium
| | - Bartosz Ditkowski
- Department of Cardiovascular Sciences, KU Leuven Center for Molecular and Vascular Biology, Leuven, Belgium.,Department of Cardiovascular Sciences, KU Leuven Cardiovascular Developmental Biology, Leuven, Belgium
| | - Ramadan Jashari
- Saint Jean Clinique, European Homograft Bank, Brussels, Belgium
| | - Petra Mela
- Department of Mechanical Engineering and Munich School of BioEngineering, Medical Materials and Implants, Technical University Munich, Munich, Germany
| | - Elizabeth A V Jones
- Department of Cardiovascular Sciences, KU Leuven Center for Molecular and Vascular Biology, Leuven, Belgium.,Department of Cardiology, CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Ruth Heying
- Department of Cardiovascular Sciences, KU Leuven Center for Molecular and Vascular Biology, Leuven, Belgium.,Department of Cardiovascular Sciences, KU Leuven Cardiovascular Developmental Biology, Leuven, Belgium
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Yazdchi F, Harloff M, Hirji S, Percy E, McGurk S, Cherkasky O, Malarczyk A, Newell P, Rinewalt D, Mallidi HR, Sabe AA, Aranki S, Shekar P, Kaneko T. Long-term Outcomes of Aortic Valve Replacement With Aortic Homograft: 27 Years Experience. Ann Thorac Surg 2021; 112:1929-1938. [PMID: 33434545 DOI: 10.1016/j.athoracsur.2020.12.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 11/19/2020] [Accepted: 12/22/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Aortic homografts have been used in young patients requiring aortic valve replacement. Currently, these grafts are generally reserved for aortic valve endocarditis with or without root abscess; however, longitudinal data are lacking. Our aim was to assess the long-term safety and durability of homograft implantation. METHODS All adult patients undergoing aortic homograft implantation at a single institution from 1992 to 2019 were included. Outcomes of interest included all-cause mortality and aortic valve reoperation, studied over a median follow-up duration of 19 years. RESULTS In all, 252 patients with a mean age of 49 years were included. Infective endocarditis was the primary indication for surgery in 95 patients (38%). The endocarditis group, compared with the no-endocarditis group, had a higher prevalence of New York Heart Association class III-IV (56% vs 26%), chronic kidney disease (22% vs 1%), prior cardiac surgery (40% vs 10%), and emergency status (7% vs 0%; all P < .001). Operative mortality was higher among endocarditis patients (16% vs 0.6%, P < .001), which persisted after risk adjustment. Among patients who survived to discharge, however, there was no difference in long-term survival between the endocarditis group and no-endocarditis group. Overall survival and freedom from reoperation were 88.3% and 80% at 15 years and 87.2% and 78% at 25 years, respectively. Indications for reoperation included structural valve deterioration (83%), endocarditis (12%), and mitral valve disease (5%). Reoperative mortality occurred in 2 patients (4.9%). CONCLUSIONS Aortic homografts are associated with good long-term survival and admissible freedom from reoperation. Operative mortality is high among patients with endocarditis; however, for those who survive to discharge, long-term survival and durability are the same as for patients without endocarditis.
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Affiliation(s)
- Farhang Yazdchi
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Morgan Harloff
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sameer Hirji
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Edward Percy
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Siobhan McGurk
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Olena Cherkasky
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alexandra Malarczyk
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Paige Newell
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Daniel Rinewalt
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Hari R Mallidi
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ashraf A Sabe
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sary Aranki
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Prem Shekar
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Tsuyoshi Kaneko
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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Von Stumm M, Petersen J, Westermann D, Reichenspurner H, Girdauskas E. Treatment strategies for mixed aortic valve disease in nonelderly patients. Expert Rev Cardiovasc Ther 2019; 17:873-882. [DOI: 10.1080/14779072.2019.1702520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Maria Von Stumm
- Department of Cardiovascular Surgery, University Heart Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J. Petersen
- Department of Cardiovascular Surgery, University Heart Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - D. Westermann
- Department of Cardiology, University Heart Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hermann Reichenspurner
- Department of Cardiovascular Surgery, University Heart Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Evaldas Girdauskas
- Department of Cardiovascular Surgery, University Heart Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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11
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Antunes MJ. Is allograft aortic valve replacement still an option? When, which, where? J Thorac Cardiovasc Surg 2018; 156:1366-1367. [PMID: 29958665 DOI: 10.1016/j.jtcvs.2018.05.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 04/30/2018] [Accepted: 05/02/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Manuel J Antunes
- Center of Cardiothoracic Surgery, University Hospital and Faculty of Medicine, Coimbra, Portugal.
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