Long-term Follow-up of UFO-Procedure with the Jena Double Patch Technique for Treatment of Severe Concomitant Aortic and Mitral Valve Endocarditis

Background: Infective endocarditis (IE) is often associated with multiorgan dysfunction and mortality. Patients with double-valve IE belong to a collective of patients with in-hospital mortality reaching 40%. If abscesses are present, specifically in the intervalvular fibrous body (IVFB), the operative risk from comorbidities is supplemented with the technical challenge of having to perform complex surgical procedures restoring the entire base of the heart. We here report outcomes of mitral and aortic valve replacement with IVFB reconstruction (a.k.a. UFO-procedure) in endocarditis patients at our center, where all IE-patients with indication and consent receive surgery.

Methods: We analyzed data of all patients with IE between 06/2008 to 02/2023 in our hospital. The surgical procedure consisted of resection of the aortic valve, the anterior leaflet of the mitral valve incl. the IVFB. Additional abscesses in other areas of the aortic or mitral annuli were also drained and resected as possible. The IVFB was reconstructed on top of a mitral prosthesis with a folded and pre-prepared Dacron double patch (“Jena short pants”) and AVR or root replacement was added. Nine-years survival analysis was performed.

Results: From the 1,216 screened IE patients, 105 presented with double valve IE and 41 patients underwent the UFO-procedure. Median age was 70 years (Q1-Q3: 62.5-75), 82.9% were male and presented with prior valve surgery (73.2%), chronic obstructive pulmonary disease (20.5%), and chronic renal disease (19.5%). The median Euroscore II was 12.0 (3.5-24), and most of the patients presented prior signs of liver dysfunction: albumin (23.0, 19-29), bilirubin (13.0, 8-25.5) and MELD-XI score (12.0, 10-19). The procedure was technically successful in all patients without relevant paravalvular leaks or prosthetic dysfunction. CPB times were 250 ± 64 and Xcl times were 167 ± 35. Half of the patients (56.1%) died in the hospital mainly due to sepsis and multi-organ failure. However, survival curves normalized after 30 days compared to the less complex cases. Surviving patients reported good quality of life.

Conclusion: The UFO procedure is a technically demanding operative procedure which provides death-bound patients with massive endocarditic affection of the aortic and mitral valves incl. the IVFB a meaningful perspective if the perioperative dangers of sepsis and multi-organ failure are survived. Classic risk scores do not reflect outcomes for this specific patient population.

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Artikel online veröffentlicht:
13. Februar 2024