What question did this study set out to answer?

To determine the incidence and evaluate both short- and long-term outcomes in patients with infective endocarditis requiring patch reconstruction.

January 10, 2026Medicina0 citationsOpen Access

Outcomes After Surgical Treatment of Infective Endocarditis with Destruction of the Cardiac Skeleton

MZMascha von ZeppelinGoethe University Frankfurt AWA. WinterGoethe University Frankfurt FEFabian EmrichGoethe University Frankfurt

Key Result

Patients with infective endocarditis requiring complex patch reconstruction had a 5-year survival rate of 46.5% and a 10-year survival rate of 26.1%.

Key Points

To determine the incidence and evaluate both short- and long-term outcomes in patients with infective endocarditis requiring patch reconstruction.
Analyzed outcomes of 678 patients who underwent cardiac surgery for infective endocarditis from January 2008 to December 2024.
Primary endpoint focused on long-term survival; secondary endpoint on freedom from reoperation.
Studied incidence of abscess formation and other cardiac complications during surgical intervention.
14% of patients required complex patch reconstruction due to extensive destruction of the cardiac skeleton.
30-day mortality rate was 20%; 5-year survival rate was approximately 46.5%, and 10-year survival rate was about 26.1%.
Extensive infective endocarditis predominantly involved the left side of the heart in 97% of cases.

Structured PICO

What are the short- and long-term survival outcomes in patients undergoing complex surgical patch reconstruction for extensive infective endocarditis with destruction of the cardiac skeleton?

Population

96 patients requiring complex patch reconstruction for extensive and destructive infective endocarditis with severe involvement of the cardiac fibrous skeleton (from a larger cohort of 678 IE surgery patients), median age 68 years.

Intervention

Complex surgical intervention necessitating patch reconstruction (including combined procedures and commando or hemi-commando operations)

Comparator

Internal comparisons (native vs. prosthetic valve endocarditis; commando/hemi-commando procedures vs. cases with abscess formation but preserved aorto-mitral continuity)

Outcome

Long-term survivalhard clinical

Complex patch reconstruction for extensive infective endocarditis with cardiac skeleton destruction carries a 20% 30-day mortality and 26.1% 10-year survival, with outcomes comparable regardless of native versus prosthetic valve involvement or the need for commando procedures.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Background and Objectives: Infective endocarditis (IE) continues to represent a life-threatening clinical entity, particularly in patients with advanced involvement of the cardiac fibrous skeleton. This study was designed to determine the incidence and to evaluate both short- and long-term outcomes in patients undergoing complex surgical intervention necessitating patch reconstruction for extensive and destructive IE. Materials and Methods: Between January 2008 and December 2024, 678 patients underwent cardiac surgery for IE at University Hospital Frankfurt/Main. The primary endpoint was long-term survival; the secondary endpoint was freedom from reoperation. Results: Ninety-six patients (14%) required complex patch reconstruction, owing to the severe involvement of the cardiac fibrous skeleton. The median age was 68 years (interquartile range IQR, 16.5 years). Forty-three patients underwent redo surgery following previous cardiac procedures. Abscess formation was identified in 88% of cases (n = 85). Infective endocarditis was predominantly left-sided in 97% of patients (n = 94). In 40 patients (41%), the aortomitral continuity or the left ventricular outflow tract (LVOT) was involved. Combined surgical procedures were performed in 85 patients (87.6%), including 19 commando or hemi-commando operations. Thirty-day mortality was 20% (n = 19). The estimated 5- and 10-year survival rates were 46.5 ± 5.5% and 26.1 ± 6.8%, respectively. Survival did not differ significantly between native and prosthetic valve endocarditis, nor between commando/hemi-commando procedures and cases with abscess formation but preserved aorto-mitral continuity. Conclusions: In industrialized countries, extensive IE with abscess formation or destruction of the cardiac skeleton is predominantly associated with Staphylococcus aureus. Patients undergoing commando or hemi-commando procedures do not experience inferior survival compared with other patients with extensive IE. No survival advantage was observed for native versus prosthetic valve IE in the presence of extensive abscess formation.

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