Replacement of the aortic root for acute prosthetic valve endocarditis: prosthetic composite versus aortic allograft root replacement.
OBJECTIVE
Aortic root replacement for prosthetic aortic valve endocarditis with accompanying destruction of the aortic root is a well-established surgical intervention. However, there is still no consensus whether prosthetic material or allogeneic material should be used. Here we report on our experience with prosthetic composite and aortic allograft root replacement in such patients during a 10-year interval.


METHODS
From 1991 through 2001, 29 patients with prosthetic aortic valve endocarditis combined with aortic root destruction underwent reoperation at our institution. Sixteen patients received aortic root replacement with a cryopreserved aortic root allograft (group A) and 13 with a prosthetic composite graft (group B). The interval between the initial operation and reoperation was 29 months (range, 5-168 months) in group A and 55 months (range, 7-248 months) in group B.


RESULTS
Hospital mortality was 18.5% (n = 5 patients, 3 in group A and 2 in group B). Median follow-up was 21 months (range, 1-48 months) for group A and 34 months (range, 1-152 months) for group B (P >.2). Survival at 1 and 5 years was 81% +/- 10% and 81% +/- 10% in group A and 85% +/- 10% and 85% +/- 10% in group B, respectively. No patient underwent reoperation for recurrent prosthetic aortic valve endocarditis.


CONCLUSIONS
Our results indicate that excellent long-term results can be achieved regardless of the material used for aortic root replacement in patients with prosthetic aortic valve endocarditis.
Leyh
Rainer G
RG
Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Hannover, Germany. leyh@thg.mh-hannover.de
Knobloch
Karsten
K
Hagl
Christian
C
Ruhparwar
Arjang
A
Fischer
Stefan
S
Kofidis
Theo
T
Haverich
Axel
A
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000601:surgery*; D001021:Aortic Valve / Q000601:surgery* / Q000637:transplantation; D001705:Bioprosthesis; D019917:Blood Vessel Prosthesis Implantation; D020878:Device Removal; D004696:Endocarditis / Q000209:etiology / Q000601:surgery*; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D010496:Pericardium / Q000637:transplantation; D014184:Transplantation, Homologous