Objective

To describe our clinical and surgical approaches for patient suffering from severe active infective endocarditis (AIE) complicated with paravalvular involvement.

Methods

From October 1979 to December 2014, 955 patients underwent surgery for AEI; among them 207 had severe AEI with paravalvular extension. The patients’ mean age was 59.9 ±15.4, and 162 (78%) were male. 137 patients (66%) had isolated aortic valve endocarditis. 138 had native valve endocarditis (67%). Follow-up was 99% complete (mean of 6.5 ±7.4 years - range, 0-34.8).

Results

The operative mortality of the cohort was 16% (n=34). Abnormal communication, mechanical valve implantation, and renal failure were independent predictors of 30-day mortality. 10 years survival was 49.3%±4.1%. Streptococcus endocarditis, complex repair and preoperative heart failure were independent predictors of long-term death. 29 patients required a reoperation (14%). Independent predictors of late reoperation were mechanical valve endocarditis and complex annulus repair.

Conclusion

AEI complicated with paravalvular involvement remains a surgical challenge. Radical debridement of all the infected tissues is mandatory, especially for Streptococcus endocarditis according to our experience. Conventional prosthetic valves, bioprosthesis even more than mechanical valves, are associated with favourable outcomes in case of severe AIE.