Surgical treatments for infective endocarditis involving valve annulus.

Objective: The early and late results of infective endocarditis (IE) with annular involvement were studied by focusing on surgical findings and operative procedures.

Materials And Methods: Fifteen adult patients with a mean age of 56 years were reviewed. Eight had native valve endocarditis (NVE), and 7 had prosthetic valve endocarditis (PVE). The diseased valve was mitral in 6 patients, aortic in 8, and mitral plus aortic in 1. Twelve patients were operated on during the active phase of IE. Enterococcus, Staphyrococcus, Streptococcus, and Stenotrophomonaus Maltophilia were predominant in bacterial examination. The mean follow-up period was 37 months.

Results: Active vegetation was observed in 63% of total patients. In NVE patients, valve replacement was performed in all 8 after complete debridement and annular patch reconstruction. One patient with hemodialysis died of heart failure. In PVE patients, valve deficiency was observed in all and active perivalvular abscess in 4. Conventional valve replacement was performed in 4 patients, and 3 of them died after surgery. Three patients who underwent aortic root translocation or Ross procedure survived. The hospital mortality of NVE and PVE surgery was 3% and 43%, respectively. There were no significant correlations between operative results and perioperative factors. During the follow-up period, late recurrent endocarditis did not occur, and one patient died of noncardiac diseases.

Conclusion: For NVE, good operative results were obtained after complete resection of infected valve annulus and valve replacement. For PVE, new surgical treatments, such as the translocation method or Ross procedure, should be induced for further improvement of surgical results.