HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Dossche, K. Articles by Ernst, J. Search for Related Content PubMed PubMed Citation Articles by Dossche, K. Articles by Ernst, J.

European Journal of Cardio-Thoracic Surgery, Vol 12, 47-55, Copyright © 1997 by European Association for Cardio-thoracic Surgery

ARTICLES

Aortic root replacement with human tissue valves in aortic valve endocarditis

K Dossche, A Brutel de la Riviere, W Morshuis, M Schepens and J Ernst
Department of Cardiopulmonary Surgery, Sint-Antonius Hospital, Nieuwegein, Netherlands.

OBJECTIVE: Aortic allograft and pulmonary autograft aortic root replacement in native and prosthetic aortic valve endocarditis are evaluated and risk factors for hospital death are assessed by univariate risk factor analysis. METHODS: From April 1989 to May 1996, 59 patients with aortic valve endocarditis (27 native; 32 prosthetic) underwent aortic root replacement with a human tissue valve. Mean age was 53.4 +/- 12.3 years; 46 patients (78%) were male. The mean preoperative NYHA functional class was 3.4. The predominant infective organisms were streptococci (30%) in the native valve group and staphylococci (30%) in the prosthetic valve group. In native valve endocarditis, valve destruction (32%) was the predominant finding. Abscesses, either annular (29%) or subannular (36%) and valve dehiscence (36%) were the most common findings in patients with prosthetic valve endocarditis. Partial or total ventriculo-aortic discontinuity (20%) and aortico-mitral discontinuity (27%) were other important operative observations. A cryopreserved allograft was used in 53 patients (89.5%), the pulmonary autograft (Ross procedure) in 5 patients (8.5%), and a fresh antibiotic sterilized allograft root in one patient (2%). Mean aortic cross-clamp time was 131 +/- 32 min. In active native and prosthetic valve endocarditis, intravenous antibiotics were continued for at least 6 weeks, monitored by serial CRP measurements. RESULTS: Hospital mortality was 8.5% (n = 5; 70% CL: 4.9-12.1%). Univariate risk factors for hospital mortality were age (P = 0.001), preoperative New York Heart Association functional class (P = 0.001), pre- (P = 0.001) and postoperative (P = 0.001) renal insufficiency. Major complications were allograft failure (n = 1; 2%), technical failure (n = 1; 2%) and false aneurysm formation at the proximal suture line (n = 1; 2%). Follow-up was complete, mean 33.1 +/- 20.1 months. Two late deaths occurred. Actuarial five year survival was 88.8% (70% CL: 80.0-97.5%); actuarial five year freedom from recurrent endocarditis was 98.1% (70% CL: 94.5-100%). CONCLUSION: Allograft aortic root replacement is a valuable technique in the life threatening situations both of native and prosthetic aortic valve endocarditis with involvement of the annular and peri-annular region.

This article has been cited by other articles:

				D. Delay, M. Pellerin, M. Carrier, R. Marchand, P. Auger, L. P. Perrault, Y. Hebert, R. Cartier, P. Page, and L. C. Pelletier Immediate and long-term results of valve replacement for native and prosthetic valve endocarditis Ann. Thorac. Surg., October 1, 2000; 70(4): 1219 - 1223. [Abstract] [Full Text] [PDF]

				K. M. Dossche, M. Erwin Tan, M. A. Schepens, W. J. Morshuis, and A. Brutel de la Riviere Twenty-four year experience with reoperations after ascending aortic or aortic root replacement Eur. J. Cardiothorac. Surg., December 1, 1999; 16(6): 607 - 612. [Abstract] [Full Text] [PDF]

				M. A.A.M. Schepens, K. M. Dossche, and W. J. Morshuis Reoperations on the ascending aorta and aortic root: pitfalls and results in 134 patients Ann. Thorac. Surg., November 1, 1999; 68(5): 1676 - 1680. [Abstract] [Full Text] [PDF]

				K. M. Dossche, A. B. de la Riviere, W. J. Morshuis, M. A.A.M. Schepens, S. M. Ernst, and J. J. van den Brand Aortic root replacement with the pulmonary autograft: an invariably competent aortic valve? Ann. Thorac. Surg., October 1, 1999; 68(4): 1302 - 1307. [Abstract] [Full Text] [PDF]

				K. M. Dossche, A. Brutel de la Riviere, W. J. Morshuis, M. A.A.M. Schepens, J. J.A.M. Defauw, and S. M. Ernst Cryopreserved aortic allografts for aortic root reconstruction: a single institution's experience Ann. Thorac. Surg., June 1, 1999; 67(6): 1617 - 1622. [Abstract] [Full Text] [PDF]