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Original Articles: Cardiovascular

Surgical Treatment of Active Aortic Endocarditis: Homografts Are Not the Cornerstone of Outcome

^a Département de Cardiologie, Hôpital Timone, Marseille, France
^b Service de Chirurgie Cardiaque, Hôpital Timone, Marseille, France
^c LERTIM, Faculté de Médecine de Marseille, Hôpital Timone, Marseille, France
^d Fédération de Microbiologie, Hôpital Timone, Marseille, France

Accepted for publication June 15, 2007.

^_* Address correspondence to Dr Habib, La Timone Hospital, Cardiology, Blvd Jean Moulin, Marseille, 13005, France (Email: gilbert.habib{at}free.fr).

Background: Surgical treatment of active aortic infective endocarditis is challenging, and the type of prosthesis to be implanted during the active phase remains controversial.

Methods: All consecutive patients with definite diagnosis of aortic infective endocarditis operated on during the active phase were included. Endpoints were in-hospital mortality and a combined endpoint including infective endocarditis recurrence, prostheses dysfunction, or long-term cardiovascular mortality.

Results: Among 127 consecutive patients, mean age 57 ± 15 years, 87% male, 30% with preexisting aortic prosthesis, and 63 (50%) with annulus abscess, 54 (43%) were treated with aortic homograft and 73 (57%) with conventional prosthesis. Median time between diagnosis and surgery was 10 days. In-hospital mortality was 9%, not different between homograft and conventional prostheses (11% versus 8%, p[ = 0.6). By multivariable analysis, prosthetic valve endocarditis (8.5 95% confidence interval: 2.2 to 33.6, ]p = 0.001) was the only variable independently associated with in-hospital mortality, which was not influenced by type valvular substitute (p = 0.6), even in the subset with annulus abscess (p = 0.2). Ten-year survival free from the combined endpoint was 44% ± 10%, not different between homograft and conventional prostheses (log rank p = 0.2). By multivariable analysis, comorbidity index (2.6 [1.05 to 6.3], p = 0.04) and prosthetic valve endocarditis (2.3 [1.2 to 4.6], p = 0.02) were independently predictive of the combined endpoint, which was not determined by type of valvular substitute (p = 0.6) even in the subset with annulus abscess (p = 0.5).

Conclusions: Implantation of conventional prostheses during the active phase of aortic endocarditis yields similar low operative mortality and long-term prognosis as compared with aortic homografts, even in patients with annulus abscess.

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Invited commentary

Tomislav Mihaljevic
Ann. Thorac. Surg. 2007 84: 1942. [Extract] [Full Text] [PDF]

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