Key result
The Commando procedure was associated with a significantly higher 30-day mortality compared to the Hemi-Commando procedure (75% vs 19%, OR 13.00) in patients with invasive double-valve endocarditis.
Why the study?
Invasive double-valve endocarditis with structural damage of the aorto-mitral curtain is a relatively rare but fatal diagnosis requiring complex surgical reconstruction.
What are the short- and mid-term outcomes of complex surgical reconstruction of the aorto-mitral continuity in patients with invasive double-valve endocarditis?
Cohort (n=20)
No
What are the short- and mid-term outcomes of complex surgical reconstruction of the aorto-mitral continuity in patients with invasive double-valve endocarditis?
Odds Ratio: 13 (95% CI 0.98–172.95)
Absolute Event Rate: 75% vs 19%
p-value: p=0.0340
Complex surgical reconstruction for invasive double-valve endocarditis carries high postoperative morbidity and mortality but offers acceptable mid-term survival for an otherwise fatal condition.
Single-center retrospective outcomes in rare double-valve endocarditis are hypothesis-generating; larger prospective studies needed before practice change.
Background: Invasive double-valve endocarditis with structural damage (abscess or perforation) of the aorto-mitral curtain is a relatively rare but fatal diagnosis requiring complex surgical reconstruction. This study presents the short-term and mid-term outcomes from a single center. Methods: = 4). Data were obtained retrospectively. Results: In 13 cases, the procedure was a reoperation. The mean cardiopulmonary bypass time was 239 ± 47 min and the mean cross-clamp time was 186 ± 32 min. Concomitant procedures were tricuspid valve repair in two, coronary revascularization in one, closure of a ventricular septal defect in one and hemiarch (using circulatory arrest) in one patient. Eleven patients (55%) required surgical revision for bleeding. Thirty-day mortality was 30% (6 patients)-3 patients from the Hemi-Commando group (19%) and 3 patients from the Commando group (75%). Overall survival at 1, 3 and 5 years was 60%, 50% and 45% respectively. Reoperation was required by 4 patients. Freedom from reoperation at 1, 3 and 5 years was 86%, 71% and 71% respectively. Conclusion: Despite the high postoperative morbidity and mortality, complex surgical reconstruction of the aorto-mitral continuity of patients with double-valve endocarditis represents the only real chance for survival. Mid-term outcomes are acceptable, but strict follow-up is required due to the risk of valve failure.
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Voborník et al. (2023) conducted a cohort in Invasive double-valve endocarditis with structural damage of the aorto-mitral curtain (n=20). Commando procedure vs. Hemi-Commando procedure was evaluated on 30-day mortality (OR 13.00, 95% CI 0.98-172.95, p=0.0340). The Commando procedure was associated with a significantly higher 30-day mortality compared to the Hemi-Commando procedure (75% vs 19%, OR 13.00) in patients with invasive double-valve endocarditis.