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Unexplained fever after aortic valve replacement with cryopreserved allografts
O M Shapira1, J D Fonger, K Reardon
1Department of Cardiothoracic Surgery, University Hospital, Boston University Medical Center, MA 02118, USA.
The Annals of Thoracic Surgery
|August 1, 1995
Summary
Patients receiving allograft aortic valve replacement have a high incidence of fever of unknown origin (FUO). This noninfectious fever resolves without treatment, but its cause remains unclear, possibly related to rejection.
Area of Science:
- Cardiology
- Immunology
- Infectious Diseases
Background:
- Fever of unknown origin (FUO) is a diagnostic challenge post-cardiac surgery.
- Aortic valve replacement (AVR) carries risks of postoperative complications, including fever.
Purpose of the Study:
- To investigate the incidence and characteristics of FUO in patients undergoing AVR with different prosthetic materials.
- To compare FUO rates between cryopreserved allografts, mechanical prostheses, and porcine xenografts.
Main Methods:
- Retrospective study of 3 groups of patients undergoing AVR.
- FUO defined as fever >38.3°C after postoperative day 3 with negative fever work-up.
- Comparison of FUO incidence across allograft, mechanical, and xenograft AVR groups.
Main Results:
- 26% of allograft AVR patients developed FUO, significantly higher than mechanical (2%) or xenograft (8%) groups (p=0.0034).
- Allograft FUO occurred postoperatively days 4-6, was self-limiting (24-48h), and seen in younger patients.
- White blood cell counts in FUO patients were lower than those with documented infection.
Conclusions:
- Cryopreserved allograft AVR is associated with a high incidence of noninfectious postoperative fever.
- The etiology of this FUO is unknown, but low-grade rejection is a potential factor.
- Further research is needed to elucidate the cause of FUO after allograft AVR.