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European Heart Journal 1995 16(Supplement B):99-102; doi:10.1093/eurheartj/16.suppl_B.99
Copyright © 1995 by the European Society of Cardiology.
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© 1995 The European Society of Cardiology

Extra-annular procedures in the surgical management of prosthetic valve endocarditis

P. Nataf, F. Jault, R. Dorent, E. Vaissier, V. Bors, A. Pavie, C. Cabrol and I. Gandjbakhch

Service de Chirurgie Cardiaque, Hôpîtal de la Pitie Paris, France

Correspondence to: Professor I. Gandjbakhch, Service de Chirurgie Cardiaque, Hôpîtal de la Pitie, 83 Bd de L'Hôpîtal, 75013 Paris, France.

Severe acute endocarditis can be associated with major destruction of the annulus. Meticulous surgical debridement friable necrotic material is always necessary and major damage to the annulus of the valve may impair secure seating of the prosthesis. Extra-annular implantation of a prosthesis may be a life-saving procedure when annular implantation is impossible. Between 1978 and 1989, 36 patients underwent extra-annular complex procedures for annular abscesses. The infection involved the aortic prosthesis and the annulus in 22 patients, and the mitral prosthesis and the annulus in 14 patients. In cases of aortic root abscess, a subcoronary coronary valved graft (11 patients), a supracoronary 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 of a mitral prosthesis was performed. In such cases, repair of the aortic root with a valved conduit or intra-atrial implantation of a mitral valvular prosthesis can be life saving and can be expected to give excellent long-term results.

Key Words: Acute endocarditis • prosthetic valve endocarditis • annular abscesses • extra-annular procedures


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