AUTHOR=Vobornik Martin , Timbilla Salifu , Gofus Jan , Smolak Petr , Chek James Lago , Pojar Marek , Cermakova Eva , Zacek Pavel , Vojacek Jan 

TITLE=Aorto-mitral curtain reconstruction in invasive double-valve endocarditis: mid-term outcomes

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 10 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2023.1154129

DOI=10.3389/fcvm.2023.1154129

ISSN=2297-055X

ABSTRACT=Background
Invasive double-valve endocarditis with structural damage (abscess or perforation) of the aorto-mitral curtain is a relatively rare but fatal diagnosis requiring complex surgical reconstruction. This study presents the short-term and mid-term outcomes from a single center. 
Methods
From 2014 to 2021, 20 patients with double-valve endocarditis with structural damage of the aorto-mitral curtain underwent surgical reconstruction (Hemi-Commando procedure n = 16 and Commando procedure n = 4). Data were obtained retrospectively.
Results
In 13 cases, the procedure was a reoperation. The mean cardiopulmonary bypass time was 239 ± 47 minutes and the mean cross-clamp time was 186 ± 32 minutes. Concomitant procedures were tricuspid valve repair in two, coronary revascularization in one, closure of a ventricular septal defect in one and hemiarch (using circulatory arrest) in one patient. Eleven patients (55 %) required surgical revision for bleeding.
Thirty-day mortality was 30 % (6 patients) – 3 patients from the Hemi-Commando group (19 %) and 3 patients from the Commando group (75 %). Overall survival at 1, 3 and 5 years was 60 %, 50 % and 45 % respectively. Reoperation was required by 4 patients. Freedom from reoperation at 1, 3 and 5 years was 86 %, 71 % and 71 % respectively.
Conclusion
Despite the high postoperative morbidity and mortality, complex surgical reconstruction of the aorto-mitral continuity of patients with double-valve endocarditis represents the only real chance for survival. Mid-term outcomes are acceptable, but strict follow-up is required due to the risk of valve failure.