Outcomes in aortic and mitral valve replacement with intervalvular fibrous body reconstruction

Abstract

Background: Surgery for intervalvular fibrous body reconstruction in aortic and mitral valve replacement is a complex operation, although mandatory in some circumstances. The long-term result of this operation remains unknown. The objective of this study was to analyze the outcomes of this technique.

Methods: A descriptive and retrospective study was carried out to analyze operative morbidity and mortality in fibrous body reconstruction with the "David technique" and to evaluate the midterm and long-term results regarding durability and survival.

Results: A total of 40 consecutive patients underwent the David technique between 1997 and 2014. The mean age was 58 ± 15 years and 62.5% were male. The indications were active endocarditis with paravalvular and fibrous body abscesses in 26 patients (group A) and massive calcification of the intervalvular fibrous body in 14 patients (group B). Mean European system for cardiac operative risk evaluation I predicted risk of mortality was 36 ± 24 and 16 ± 15, respectively. The hospital mortality rate was 15.3% in group A and 7.1% in group B. Survival rate after 1, 5, and 10 years was 65.4%, 57.7%, and 50% for group A and 92.9%, 85.7%, and 78.6% for group B. Freedom from reoperation at 1, 5, and 10 years was 92.3%, 84.6%, and 76.9% for group A and 90.9%, 90.9%, and 90.9% for group B. Mean follow-up was 53 ± 8 months.

Conclusions: Although this complex operation is associated with high perioperative mortality, the long-term results are acceptable in patients where there are not suitable alternative procedures.