The impact of aortic valve homografts on the treatment of aortic prosthetic valve endocarditis.
Prosthetic valve endocarditis, which is an uncommon but potentially fatal complication of valve replacement, may result in annular abscess formation (mechanical valves) or primarily leaflet infection (xenografts and homografts). Insertion of a mechanical or xenograft valve in the setting of aortic root infection carries a risk of reinfection, which is highest in the first 4 months after valve replacement. In contrast, the homograft aortic valve does not have this early risk of prosthetic valve endocarditis, but instead a constant and low risk across time. Because of this apparent intrinsic resistance to infection, the aortic homograft valve is the replacement device of choice for prosthetic valve endocarditis. An additional advantage of the homograft aortic valve for prosthetic valve endocarditis is the fact that this device has the flexibility to enable its use even in extensive aortic root destruction, including left ventriculo-aortic discontinuity. The homograft valve can be inserted as a root replacement after excision of the infected aortic root, or as a subcoronary or cylindrical technique for less extensive infection.
McGiffin
D C
DC
Department of Surgery, University of Alabama at Birmingham 35294-0007.
Kirklin
J K
JK
D001021:Aortic Valve / Q000601:surgery / Q000637:transplantation*; D004697:Endocarditis, Bacterial / Q000601:surgery*; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D011474:Prosthesis Design; D016459:Prosthesis-Related Infections / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D012307:Risk Factors; D014183:Transplantation, Heterologous; D014184:Transplantation, Homologous