Acute aortic endocarditis with annular destruction: assessment of surgical treatment with cryopreserved valvular homografts.
OBJECTIVE
Valve ring abscesses in acute infective aortic endocarditis have a low, though not insignificant, prevalence. Surgical treatment with implantation of prosthetic valves may lead to major life-threatening complications, such as recurrent endocarditis and partial or complete prosthetic dislocation. Valvular homografts may offer a higher resistance to recurrent infection and have thus become recognized as an excellent and safe substitute for orthotopic left ventricular outflow reconstruction.


METHODS
Between May 1991 and July 1996, 25 patients underwent surgical treatment for aortic endocarditis with annular destruction. Staphylococcus spp. were present in 32% of patients and Streptococcus spp. in 48%. Seven aortic valve replacements (AVR) and 18 aortic root replacements (ARR) were performed using cryopreserved valvular homografts. All grafts were implanted in the subannular position.


RESULTS
The overall outcome was good in 23 patients, two died in the early postoperative period. Mean follow up was 38 +/- 18 months (range: 14 to 76 months). No recurrence of endocarditis was detected and no significant alterations of the implants were described. Transvalvular gradients were significantly lower in ARR patients than in AVR patients.


CONCLUSIONS
Despite the severity of the tissue damage, cryopreserved homografts, when implanted in the subannular position, constitute a safe and reproducible surgical treatment of aortic endocarditis with annular involvement.
Grandmougin
D
D
Department of Cardiovascular Surgery, Hopital Cardiologique, CHRU-Lille, France.
Prat
A
A
Fayad
G
G
Decoene
C
C
Pol
A
A
Warembourg
H
H
D000208:Acute Disease; D000328:Adult; D000368:Aged; D001021:Aortic Valve; D015925:Cryopreservation; D004697:Endocarditis, Bacterial / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014463:Ultrasonography