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Ann Thorac Surg 2009;88:1814-1821. doi:10.1016/j.athoracsur.2009.08.019
© 2009 The Society of Thoracic Surgeons
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Loes M.A. Klieverik
Magdi H. Yacoub
Johanna J.M. Takkenberg
Ad J.J.C. Bogers
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Original Articles: Adult Cardiac

Surgical Treatment of Active Native Aortic Valve Endocarditis With Allografts and Mechanical Prostheses

Loes M.A. Klieverik, MDa,*, Magdi H. Yacoub, MD, PhDb, Sue Edwards, BSb, Jos A. Bekkers, MDa, Jolien W. Roos-Hesselink, MD, PhDc, A. Pieter Kappetein, MD, PhDa, Johanna J.M. Takkenberg, MD, PhDa, Ad J.J.C. Bogers, MD, PhDa

a Department of Cardio Thoracic Surgery, Erasmus Medical Center Rotterdam, the Netherlands
c Department of Cardiology, Erasmus Medical Center Rotterdam, the Netherlands
b Harefield Heart Science Center, National Heart and Lung Institute, Harefield, United Kingdom

Accepted for publication August 11, 2009.

* Address correspondence to Dr Klieverik, Department of Cardio Thoracic Surgery, Bd 571, Erasmus Medical Center Rotterdam, PO Box 2040, Rotterdam, 3000 CA, the Netherlands (Email: l.klieverik{at}erasmusmc.nl).

Background: Surgical intervention for persistent active native aortic valve endocarditis (NVE) remains challenging. We analyzed our combined experience with allografts and mechanical prostheses (MP) in NVE operations.

Methods: Between 1980 and 2002, 138 patients (81% males) underwent aortic valve replacement for NVE in 2 centers (106 allografts; 32 MPs). Perioperative characteristics and early and late morbidity and mortality were analyzed.

Results: Mean age was 47 years (range, 14 to 76 years), and 34% required emergency surgery. Abscess rate was 38% for allografts vs 18% for MPs. Concomitant mitral valve replacement was required in 38% MP patients and in 5% allograft patients. Hospital mortality was 8% (n = 11; p = 0.25): 10 allograft patients (9%) and 1 MP patient (3%). During a mean 8-year follow-up (range, 0 to 25 years) 33 patients died: 22 allograft (24%) and 11 MP patients (21%; p = 0.14). Survival at 15 years was 59% ± 6% for allograft patients and 66% ± 9% for MP patients (p = 0.68). Late recurrent endocarditis developed in 6 allograft patients and 1 MP patient (p = 0.29). Overall 15-year freedom from reoperation was 76% ± 9% for allografts and 93% ± 6% for MPs (p = 0.02).

Conclusions: Mechanical prostheses have comparable rates of midterm survival and freedom from recurrent infection. However, this is in combination with extensive excision of destructive tissue in a specific patient subset. Allograft reoperation rates increase with time. The importance of the mechanical prosthesis in NVE might be established in the coming years.




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