The Quattro valve and active infective endocarditis of the mitral valve

Background and aim of the study: Even today, infective endocarditis remains a therapeutic challenge. Active endocarditis at the time of valve implanta tion is an important risk factor for the development of prosthetic valve in fection. This study reports results following implantation of the Quattro v alve, a stentless chordally supported quadrileaflet mitral valve made from bovine pericardium. Methods: The Quattro valve was implanted in seven patients (four females, t hree males; mean age 34 years) requiring isolated mitral valve replacement for active bacterial endocarditis. All had congestive heart failure; two we re in cardiogenic shock. The diagnosis of active endocarditis was based on clinical and echocardiographic findings, together with macroscopic evidence of acute infection at surgery, blood culture or histopathological evidence of valve infection. Postoperatively, all patients received at least four w eeks of parenteral antibiotic therapy. Results: Congestive heart failure (and large pedunculated vegetations and m obile septic left atrial thrombi in two patients) prompted early surgical i ntervention. Patients underwent surgery at a mean of 7 days (range: 1-16 da ys) after admission. Endocarditis was caused by Cram-positive cocci in all patients except one. At a mean follow up of 15 months (range: 6-24 months) all patients were alive and symptomatically improved. To date, all remain f ree of prosthetic valve endocarditis, reoperation and thromboembolism. Conclusion: The Quattro valve can be implanted safely in patients with acut e bacterial endocarditis. The results also reflect the benefit of early sur gical intervention in patients with infective endocarditis complicated by c ongestive heart failure, with or without large vegetations.