Six-year experience with cryopreserved mitral homografts in the treatment of tricuspid valve endocarditis in HIV-infected drug addicts.
OBJECTIVE
In the past, valve homografts have been used in the treatment of aortic endocarditis. This report details our experience in tricuspid valve replacement using cryopreserved mitral homografts in HIV-positive drug addicts with infective endocarditis.


METHODS
Five HIV-1-infected drug addicts with active uncontrollable tricuspid valve endocarditis underwent tricuspid valve replacement with a cryopreserved mitral homograft.


RESULTS
There was no early mortality, and median follow up was 5 years (range: 1 to 6 years). One late mortality occurred as a result of heroin overdose. Three of the five patients developed six episodes of recurrent bacterial tricuspid endocarditis on the homograft; these were cured successfully with antibiotics. All survivors remain in NYHA functional class I. The latest transthoracic echocardiography examination showed mild, moderate or severe regurgitation in one, two and two patients, respectively. To date, neither homograft calcification nor rupture of the papillary muscle has been detected.


CONCLUSIONS
This novel technique is considered to be an adequate approach to these cases of uncontrollable infectious disease. Further episodes of valvular infection can be managed medically.
Mestres
C A
CA
Department of Cardiovascular Surgery, Hospital Clinic, University of Barcelona, Spain.
Miro
J M
JM
Pare
J C
JC
Pomar
J L
JL
D000328:Adult; D002177:Candidiasis / Q000150:complications / Q000601:surgery; D015925:Cryopreservation; D004452:Echocardiography; D004696:Endocarditis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D004697:Endocarditis, Bacterial / Q000150:complications / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications*; D015497:HIV-1; D006349:Heart Valve Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D006556:Heroin Dependence / Q000150:complications*; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000637:transplantation*; D012008:Recurrence; D014184:Transplantation, Homologous; D014261:Tricuspid Valve / Q000000981:diagnostic imaging / Q000601:surgery*