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Original Articles: Adult Cardiac

Graft Selection for Aortic Root Replacement in Complex Active Endocarditis: Does It Matter?

Division of Cardiovascular Surgery, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania

Accepted for publication September 28, 2011.

^_* Address correspondence to Dr Pochettino, Division of Cardiovascular Surgery, University of Pennsylvania School of Medicine, Hospital of the University of Pennsylvania, 3400 Spruce St, 6 Silverstein Pavilion, Philadelphia, PA 19104-4283 (Email: alberto.pochettino{at}uphs.upenn.edu).

Presented at the Poster Session of the Forty-seventh Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Jan 31–Feb 2, 2011.

Background: Endocarditis affecting the aortic valve, with abscess formation and root destruction, remains a challenge to treat. Aortic root homografts have been advocated because of a perceived lower risk of infective complications than with other root replacement grafts. However, the theoretical advantage of homografts has not been re-evaluated in the modern era. This report is based on an examination of our results for all aortic root replacements in complex, active endocarditis affecting the aortic valve.

Methods: From 2000 to 2010, 134 patients (70.9% male; mean age 58.3 ± 14.8 years) at our institution underwent aortic root replacement for active endocarditis. Ninety of the patients (67.2%) had a previously implanted prosthetic aortic valve. Our findings for these patients included one or more of the following: abscess (n = 110, 82.1%), valve vegetation (n = 98, 73.1%), and pseudoaneurysm or rupture or both (n = 62, 46.3%). We retrospectively reviewed data for the patients from hospital records and the social security data base.

Results: A mechanical composite graft (MC) was used in 43 of the patients (32.1%), a non-homograft biologic valve conduit (BC) in 55 patients (41.0%), and a homograft (HG) valve in 36 patients (26.9%). There was no significant difference among the groups in the incidence of major complications or in-hospital mortality. During a mean follow-up of 32.1 ± 29.4 months, the rates of readmission, reinfection, and reoperation were similar for the three groups. The mean 5-year survival in the study was 58 ± 9% for the MC group, 62 ± 7% for the BC group, and 58 ± 9% for the HG group, respectively (p = 0.48).

Conclusions: Aortic root replacement in the presence of complex active infection is associated with significant morbidity and mortality. We report that the rates of major complications and late mortality were similar among MC, BC, and HG groups in our study.

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Invited Commentary

Michael A. Borger
Ann. Thorac. Surg. 2012 93: 488. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

				M. Wilbring, S. M. Tugtekin, K. Alexiou, K. Matschke, and U. Kappert Composite Aortic Root Replacement for Complex Prosthetic Valve Endocarditis: Initial Clinical Results and Long-Term Follow-Up of High-Risk Patients Ann. Thorac. Surg., December 1, 2012; 94(6): 1967 - 1974. [Abstract] [Full Text] [PDF]

				M. A. Borger Invited Commentary Ann. Thorac. Surg., February 1, 2012; 93(2): 488 - 488. [Full Text] [PDF]