Porcine stentless aortic valve in re-replacements and acute aortic valve endocarditis

Between June 1990 and June 1993, 135 patients received a porcine stentless aortic valve (PSAV) at our institution. In this group, there were 33 patients in whom the stentless valve was used to replace a previously inserted malfunctioning aortic valve prosthesis (n = 19) or to treat acute aortic valve endocarditis (n = 14, five native, nine prosthetic endocarditis). There was one hospital death caused by multiple organ failure in a patient with endocarditis and preoperative cerebral stroke. Two patients died after hospital discharge; one suffered sudden death following a pacemaker failure four month after surgery and the other died due to Candida albicans sepsis after a prolonged antibiotic treatment. There were two reoperations; one to correct a dehiscence of the proximal suture line and the other to replace a degenerated valve 3.5 years after implantation in a 14 year old boy. All operative survivors were followed clinically with serial color Doppler echocardiography. No recurrence of endocarditis was detected. Aortic root reconstruction was achieved even in the presence of multiple abscesses. All but one patients showed a normally functioning valve with none or minimal aortic insufficiency. In our opinion the PSAV is an excellent aortic valve substitute for patients with damaged aortic annulus, because it promotes aortic root remodeling, decreases the incidence of postoperative paravalvular leaks and helps to prevent endocarditis recurrence.