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 pres ented various forms of infectious extension to the surrounding areas T wenty-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 mi tral apparatus was infected in 26 cases, the tricuspid valvule in one case. Both tricuspid and mitral valvular replacements had to be perfor med in five cases. Among the 16 postoperative atrioventricular blocks, 14 needed a pacemaker. The most frequent causative microorganisms wer e Staphylococcus aureus and Streptococcus. Surgical management of the lesions consisted of extensive debridement followed by either simple r epair of defects or complex reconstructions involving pericardial or s ynthetic patches or other more complex operations Early and late morta lity 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 (12-26 5 months) with a survival rate of 74% (SE: +/- 0.08) at 10 years We co nclude that, although surgical correction of infective endocarditis ma y need a complex approach, it provides good results with an acceptable surgical risk.