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Aortic root replacement with cryopreserved allograft for prosthetic valve endocarditis
Joseph F Sabik1, Bruce W Lytle, Eugene H Blackstone
1Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Ohio 44195, USA. sabik@ccf.org
The Annals of Thoracic Surgery
|September 20, 2002
Summary
Radical debridement and aortic root replacement using cryopreserved aortic allografts effectively treat aortic prosthetic valve endocarditis (PVE). This approach demonstrates favorable outcomes in hospital mortality, recurrent endocarditis, and long-term survival.
Area of Science:
- Cardiovascular Surgery
- Infectious Diseases
- Transplantation Immunology
Background:
- Aortic prosthetic valve endocarditis (PVE) presents significant challenges in treatment.
- Current strategies involve radical debridement and aortic root replacement.
Purpose of the Study:
- To evaluate the effectiveness of aortic root replacement with cryopreserved aortic allografts for PVE.
- To assess hospital mortality, morbidity, recurrent endocarditis, and survival rates.
Main Methods:
- A cohort of 103 patients with aortic PVE underwent aortic root replacement with cryopreserved aortic allografts between 1988 and 2000.
- Patients had varying degrees of abscesses, aortoventricular discontinuity, and prior endocarditis operations.
- Cultures revealed diverse pathogens including Staphylococcus, Streptococcus, and fungi.
Main Results:
- Hospital mortality was 3.9%, with 31 patients requiring permanent pacemakers.
- Survival rates at 1, 2, 5, and 10 years were 90%, 86%, 73%, and 56%, respectively.
- Recurrent PVE of the allograft occurred in 4 patients, with 95% freedom from recurrence at 2 years.
Conclusions:
- Radical debridement and aortic root replacement with cryopreserved aortic allografts is a safe and effective strategy for aortic PVE.
- This approach is recommended for managing complex cases of aortic prosthetic valve endocarditis.