Homograft aortic root replacement for complicated prosthetic valve endocarditis

Ten patients with late-onset prosthetic valve endocarditis, uncontrolled sepsis, and aortic root abscesses underwent homograft aortic root replacement with reimplantation of the coronary arteries. There were two perioperative deaths. The necrotizing endocarditis was cured in all eight survivors, who have been followed from 6 to 132 months (mean 3 1/2 years). Two of these patients are having symptoms caused by biological valve malfunction; excellent clinical and hemodynamic results have been obtained in the remaining six patients. Homograft aortic root replacement excludes the root abscesses and the weakened infected aortic anulus from the high systemic pressures and permits suturing to a bed of the aortic root in continuity with healthy myocardium. This operation provides an alternative technique to the management of selected patients with active prosthetic infection and destruction of the aortic ring by sepsis.