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The Annals of Thoracic Surgery, Vol 49, 619-624, Copyright © 1990 by The Society of Thoracic Surgeons
IC Tuna, TA Orszulak, HV Schaff and GK Danielson
Since July 1985, cryopreserved homograft prostheses have been used for
aortic valve replacement in 10 patients, aged 2 to 77 years, with active
endocarditis. Five patients had positive bacterial cultures from excised
valves, and all had clinical findings of uncontrolled infection while
receiving appropriate antibiotics. Homograft valves (four) or valved
conduits (six) were implanted for treatment of sepsis (6 patients),
congestive heart failure (3) or recurrent emboli (1 patient), and
complicating native (5 patients) or prosthetic valve (5) endocarditis.
Staphylococci (6 patients), streptococci (3), and Candida (1) were
infecting organisms. Preoperatively, Doppler echocardiography showed aortic
regurgitation in all patients. At operation, 9 patients had gross
vegetations, 9 had single or multiple abscess cavities, and 5 had
pericarditis. Complex reconstruction of the aortic valve and annulus with
homograft conduits was necessary in 6 patients (3 with previous
aortoventriculoplasty). Two early deaths (ventricular failure,
perioperative stroke) occurred. Mean follow-up of all operative survivors
was 2.1 years (range, 0.6 to 3.6 years), and one late death resulted from
arrhythmia. Homograft valve regurgitation increased in 1 patient, and 7
late survivors are asymptomatic. No patient has had recurrence of
endocarditis. We conclude that cryopreserved homograft aortic valve/root
replacement is an effective method for management of active endocarditis
complicated by annular destruction.
ARTICLES
Results of homograft aortic valve replacement for active endocarditis
Section of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota 55905.
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