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Cryopreserved aortic viable homograft for active aortic endocarditis
Jean-Michel Grinda1, Jean-Luc Mainardi, Nicola D'Attellis
1Department of Cardiac Surgery, Hôpital Européen Georges Pompidou, Paris, France. jean-michel.grinda@egp.ap-hop-paris.fr
Insights
Cryopreserved aortic viable homografts (CAVH) effectively treat active aortic endocarditis, showing good short and long-term results. This method avoids prosthetic materials, offering a viable surgical option for patients with this severe infection.
Area of Science:
- Cardiovascular Surgery
- Infectious Diseases
- Transplantation
Background:
- Active aortic endocarditis presents significant challenges in valve replacement surgery.
- Destructive lesions necessitate effective treatment strategies to improve patient outcomes.
Purpose of the Study:
- To evaluate the short-term and long-term efficacy of cryopreserved aortic viable homograft (CAVH) in treating active aortic endocarditis.
- To assess the safety and durability of CAVH as an alternative to prosthetic materials.
Main Methods:
- A cohort of 104 patients with active aortic valve endocarditis underwent CAVH replacement between 1992 and 2002.
- Patients included those with native or prosthetic valve endocarditis, isolated or plurivalvular involvement.
- Intraoperative transesophageal echocardiography was systematically employed; bacteriologic diagnosis was obtained in 80% of cases.
Main Results:
- Hospital mortality was 5%. During a mean follow-up of 61 months, actuarial survival at 10 years was 83%, with 93% free from cardiac death.
- Freedom from reoperation at 10 years was 76%, and freedom from recurrent endocarditis was 93%.
- No thromboembolic complications were observed, highlighting the safety profile of CAVH.
Conclusions:
- Cryopreserved aortic viable homografts demonstrate effectiveness in managing the destructive nature of active aortic endocarditis.
- CAVH provides satisfactory immediate and long-term clinical outcomes, including low rates of reoperation and recurrent infection.
- The use of CAVH offers a valuable alternative to prosthetic materials, potentially enabling faster surgical treatment of active aortic endocarditis.
Background:
To evaluate the short and long-term results of cryopreserved aortic viable homograft (CAVH) in the treatment of active aortic endocarditis.
Methods:
From January 1992 to December 2002, 104 patients (23 females, 81 males) with a mean age 51 +/- 13 years (from 14 to 77) underwent CAVH replacement for active aortic valve endocarditis. Seventy-six patients (73%) had endocarditis of the native aortic valve, 28 (27%) had endocarditis of prosthetic aortic valve; among them, eight had a recurrent infection. Eighty-three patients (80%) had isolated aortic endocarditis. Plurivalvular endocarditis was observed in 21 (20%) patients, (aortic and mitral in 16 patients, aortic and tricuspid in 5). Intraoperative transesophageal echocardiography was systematically used. Anatomical lesions included perforations in 89 (86%) patients, vegetations in 79 (77%) patients and periannular extensions in 60 (58%) patients. Precise bacteriologic diagnosis was available in 82 (80%) patients.
Results:
Cryopreserved aortic viable homografts were inserted using the aortic root replacement technique in 93 (89%) patients and the subcoronary technique in 11 (11%) patients. Associated procedures were performed in 38 (37%) patients: mitral (n = 23) and tricuspid (n = 3) valve repair, partial homograft mitral valve replacement (n = 3), partial homograft tricuspid valve replacement (n = 3), coronary bypass graft (n = 3), and ascending aorta replacement (n = 3). Hospital mortality was 5 (5%) patients. Causes of death included: myocardial infarction (n = 2), myocardial failure (n = 2), and multiorgan failure (n = 1). During follow-up (61 +/- 36 months, from 6 months to 136 months), 9 secondary deaths occurred (2 were cardiac related), 14 aortic valvular redo surgeries were performed (2 for nonstructural failure, 6 for structural failure, and 6 for endocarditis). Actuarial survival at ten years was 83%, with 93% of the patients free from cardiac death. At ten years, actuarial rate for freedom from reoperation was 76% and freedom from recurrent endocarditis was 93%. No thromboembolic complications were observed.
Conclusions:
The CAVH has proven its effectiveness in treating the destructive lesions of active aortic endocarditis. It has provided satisfactory immediate and long-term results. Allowing the possibility to avoid a prosthetic material, CAVH could represent an option for surgically treating active aortic endocarditis more rapidly.
