EXTRA-ANNULAR PROCEDURES IN THE SURGICAL-MANAGEMENT OF PROSTHETIC VALVE ENDOCARDITIS

Severe acute endocarditis can be associated with major destruction of the annulus. Meticulous surgical debridement of friable necrotic mater ial is always necessary and major damage to the annulus of the valve m ay impair secure seating of the prosthesis. Extra-annular implantation of a prosthesis may be a life-saving procedure when annular implantat ion is impossible. Between 1978 and 1989, 36 patients underwent extra- annular complex procedures for annular abscesses. The infection involv ed the aortic prosthesis and the annulus in 22 patients, and the mitra l prosthesis and the annulus in 14 patients. In cases of aortic root a bscess, a subcoronary coronary valved graft (II patients), a supracoro nary valved conduit (ten patients) or a left ventricle-abdominal aorta valved conduit (one patient) were implanted. In cases of mitral valve endocarditis with extensive annular abscess, intra-atrial insertion o f a mitral prosthesis was performed. In such cases, repair of the aort ic root with a valved conduit or intra-atrial implantation of a mitral valvular prosthesis can be life saving and can be expected to give ex cellent long-term results.