Infective endocarditis in patients who had replacement of the aortic root

In 12 patients who had had composite replacement of the aortic valve and ascending aorta, infective endocarditis developed 2 months to 17 years after operation. Six patients had mechanical valves and 6 had biological ones (four homograft and two porcine valves). All patients needed operation because of shock, heart failure, persistent sepsis in spite of adequate antibiotic therapy, or the development of a paravalvular false aneurysm. The predominant microorganism was Staphylococcus. All 6 patients who had mechanical valves were found to have an abscess in the junction between the aortic annulus and the prosthesis; in patients who had biological valves the infection was limited to the leaflets in 3 (one homograft and two porcine valves) and leaflets and annulus abscess in 3 (three homograft valves). Operation consisted of radical resection of tissues suspected of being infected and reconstruction of the left ventricular outflow tract and of the surrounding structures with glutaraldehyde-fixed bovine pericardium. The aortic valve and ascending aorta were replaced with a new valved conduit. An aortic homograft was used in only 1 patient. There was only one operative death due to right ventricular infarction but most patients experienced serious postoperative complications. Operative survivors were followed up from 3 to 156 months (mean, 42 months). One patient died 35 months postoperatively due to bleeding complications of anticoagulation; 1 patient suffered a cardiac arrest at home 2 months after operation, sustained permanent cerebral damage, and died 4 months later. The remaining patients are asymptomatic from the cardiovascular viewpoint.(ABSTRACT TRUNCATED AT 250 WORDS)