Reoperative cryopreserved root and ascending aorta replacement for acute aortic prosthetic valve endocarditis.
BACKGROUND
Prosthetic aortic valve endocarditis (PVE) is an important complication of aortic valve replacement (AVR) and is a particularly difficult situation after an operation combining AVR with ascending aortic replacement.


METHODS
From 1988 through 2000, 27 patients with aortic valve PVE after previous ascending aortic replacement (aortic root replacement in 13, aortic valve replacement with a supracoronary graft in 14) underwent reoperation for aortic root replacement with a cryopreserved aortic allograft and prolonged intravenous antibiotic therapy. All patients were considered to have active PVE (25 with positive cultures); root abscess formation was present in 89% and aortoventricular discontinuity in 41%.


RESULTS
One patient (3.7%) died in-hospital, and permanent pacemakers were required in 10 patients (37%). Mean postoperative follow-up interval was 3.9 +/- 3.0 years, and survival at 1, 2, 5, and 7.5 years was 92%, 88%, 70%, and 56%, respectively. One patient underwent reoperation for recurrent PVE 8 months after operation.


CONCLUSIONS
Radical debridement of infected prosthetic material and tissue, and allograft aortic root and ascending aorta replacement, combined with intravenous antibiotic therapy, appears to achieve a low hospital mortality and a high degree of freedom from recurrent infection for patients with PVE after AVR and ascending aortic replacement.
Lytle
Bruce W
BW
Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Ohio 44195, USA. lytleb@ccf.org
Sabik
Joseph F
JF
Blackstone
Eugene H
EH
Svensson
Lars G
LG
Pettersson
Gosta B
GB
Cosgrove
Delos M
DM
D000038:Abscess / Q000401:mortality / Q000601:surgery; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents; D001011:Aorta / Q000637:transplantation*; D003131:Combined Modality Therapy; D015925:Cryopreservation; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D004697:Endocarditis, Bacterial / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000401:mortality / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D015996:Survival Rate; D014184:Transplantation, Homologous
D000900:Anti-Bacterial Agents