Extension of Native Aortic Valve Endocarditis: Surgical Considerations

Among 101 consecutive patients operated on for native infective aortic valve endocarditis (53 males, 48 females, mean age 39 years), 69 presented various forms of infectious extension to the surrounding areas. Twenty-six lesions were noted in the aortic roots: 18 annular abscesses, one abscess of the Valsalva sinus and seven aortic wall destructions. Among the subaortic valve pathology, 27 cases of septal lesions were noted and in one case the mitral fibrous trigone was involved. The mitral apparatus was infected in 26 cases, the tricuspid valvule in one case. Both tricuspid and mitral valvular replacements had to be performed in five cases. Among the 16 postoperative atrioventricular blocks, 14 needed a pacemaker. The most frequent causative microorganisms were Staphylococcus aureus and Streptococcus. Surgical management of the lesions consisted of extensive debridement followed by either simple repair of defects or complex reconstructions involving pericardial or synthetic patches or other more complex operations. Early and late mortality rates were 8.5% and 16%; early and late reoperation rates were 6% and 9.5%, respectively. The mean follow-up time was 148 months (12-265 months) with a survival rate of 74% (SE: +/- 0.08) at 10 years. We conclude that, although surgical correction of infective endocarditis may need a complex approach, it provides good results with an acceptable surgical risk.