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Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots
Published on: May 21, 2017
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Revisiting the guidelines and choice the ideal substitute for aortic valve endocarditis
Francesco Nappi1, Sanjeet Singh Avtaar Singh2,3, Cristiano Spadaccio2,3
1Department of Cardiac Surgery, North Cardiological Center, Saint-Denis, Paris, France.
Annals of Translational Medicine
|September 21, 2020
Summary
Choosing the right aortic valve replacement for infective endocarditis (IE) requires careful consideration of infection details and patient factors. This guide helps select prostheses and surgical strategies to ensure long-term durability and prevent infection recurrence.
Area of Science:
- Cardiovascular Surgery
- Infectious Diseases
- Biomaterials Science
Background:
- Aortic valve replacement is the most common cardiac surgery for infective endocarditis (IE).
- Current guidelines lack specific recommendations for prosthesis selection and surgical strategy in IE.
- Treatment goals focus on long-term durability and preventing infection relapse.
Purpose of the Study:
- To review literature on biological substitutes for aortic valve endocarditis (AVE).
- To compare long-term outcomes of different prostheses in AVE.
- To provide a decision-making algorithm for prosthesis and surgical strategy selection in IE.
Main Methods:
- Literature search of PubMed, EMBASE, and Cochrane Library (up to November 2019).
- Inclusion of studies reporting on biological substitutes in AVE.
- Investigation of studies comparing allogenic, autologous, and conventional prostheses.
Main Results:
- Conventional mechanical or stented xenografts are preferred for localized aortic infection.
- Homografts are recommended for complex IE involving the aortic root or aorto-mitral continuity.
- Prosthetic bioroot or valved conduits are acceptable alternatives, balancing degeneration risk.
Conclusions:
- Prosthesis and surgical strategy selection for IE is complex.
- Key factors include infection extension, microbiology, patient profile, and recurrence risk.
- A multidisciplinary approach is essential for optimal outcomes in aortic valve endocarditis management.
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