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Ann Thorac Surg 2002;74:650-659
© 2002 The Society of Thoracic Surgeons
a Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
b Department of Biostatistics and Epidemiology, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
* Address reprint requests to Dr Sabik, Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, 9500 Euclid Ave/F25, Cleveland, OH—44195 USA
e-mail: sabik{at}ccf.org
Presented at the Forty-eighth Annual Meeting of the Southern Thoracic Surgical Association, San Antonio, TX, Nov 8–10, 2001.
Background. Our strategy has been to treat aortic prosthetic valve endocarditis (PVE) with radical debridement of infected tissue and aortic root replacement with a cryopreserved aortic allograft. This study examines the effectiveness of this strategy on hospital mortality and morbidity, recurrent endocarditis, and survival.
Methods. From 1988 through 2000, 103 patients with aortic PVE underwent root replacement with a cryopreserved aortic allograft. Abscesses were present in 78%, and aortoventricular discontinuity was present in 40%. Thirty-two patients had at least one previous operation for endocarditis. In 23 patients with a history of native valve endocarditis, the allograft was implanted after one episode (17 patients), two episodes (5 patients), or three episodes of PVE (1 patient). In the 80 patients without a history of native valve endocarditis, the allograft was placed after one previous aortic valve replacement (57 patients), two (19), or three (4) previous aortic valve replacements. Among the 92 patients with positive cultures, 52 had staphylococcal organisms, 20 had streptococcal, 6 had fungal, 4 had gram-negative, and 6 had enterococcal organisms. Mean follow-up was 4.3 ± 2.9 years.
Results. Hospital mortality was 3.9%. Permanent pacemakers were required in 31 patients. Survival at 1 year, 2 years, 5 years, and 10 years was 90%, 86%, 73%, and 56%, respectively, with a risk of 5.3% per year after 6 months. Four patients underwent reoperation for recurrent PVE of the allograft (95% freedom from recurrent PVE at 
2 years). Risk of recurrent PVE peaked at 9 months and then declined to a low level by 18 months.
Conclusions. A strategy of radical debridement and aortic root replacement with a cryopreserved aortic allograft for aortic PVE is safe, effective, and recommended.
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